Glossary

Adverse Drug Event—an injury resulting from a medica-

tion or lack of intended medication.
Affected Systems—identification of pharmacy informa-
tion/ automation systems as well as hospital information
systems that support pharmacy operations and the medi-
cation use process. These systems usually consist of the
pharmacy information system (PIS), automated dispens-
ing cabinets (ADM), pharmacy robot, TPN compounding
machine, pharmacy’s intranet and/or hospital’s internet sites,
admitting/registration system (ADT/registration) for patient
access, financial systems, carousel inventory cabinets, bar
code medication administration systems (BCMA), clinical
decision support (CDS), computerized provider order entry
(CPOE), electronic medication administration record (eMAR),
clinical results/electronic healthcare record, laboratory infor-
mation systems, etc.
Alert Fatigue—a state of irritability, exhaustion, or be-
wilderment triggered in clinicians who have been exposed
to too many alerts, or alerts with a perceived history of ir-
relevance, which cause the user to ignore some or all of the
alerts, thereby reducing the safety benefit of the decision
support system.
Alert—an urgent notice generated by a computerized
clinical decision support system (CDSS). These are usually in
the form of a just-in-time, patient-specific message directed
to one or more clinicians. It may be a warning regarding a
clinician’s documented action (or lack thereof) or a docu-
mented decision. Or it may be an urgent informational noti-
fication of a new clinical condition, circumstance, or change
in patient status that requires immediate attention. Some
alerts require a response before the clinician can continue.
American National Standards Institute (ANSI)—
coordinates the development and use of voluntary consen-
sus standards including Health Level Seven’s (HL7) Arden
Syntax standard.
Application—software written to work on a computer and
designed to perform a specific task, in this context the PIS. It
is what the user sees when he opens the PIS.

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Arden Syntax Standard—an HL7 standard Carousel Automation—a medication storage
designed to allow clinicians to program medical cabinet with rotating shelves used to automate
logic into a clinical rule or guideline. The American dispensing.
Society for Testing and Materials first approved
Centers for Medicare and Medicaid Services
the Arden Syntax as a standard in 1992 (E-1460-
(CMS)—the federal healthcare programs for the
92). Ownership was transferred to HL7 and ANSI
elderly and indigent. For more information go to:
in 1999 with the approval of version 2.0 of the
http://www.cms.hhs.gov/
standard. The Arden Syntax is the only approved
standard for clinicians to encode medical logic Centralized Robotic Dispensing System—
into clinical rules known as medical logic modules centrally located devices designed to automate the
(MLM). entire process of medication dispensing including
medication storage, distribution, restocking, and
ASC X12N—Accredited Standards Committee
crediting of unit dose medications.
X12; creates standards for the cross industry elec-
tronic transmission of business information. ASC Change Management—a discipline in in-
X12N standards are used for insurance eligibility formation systems service that seeks to ensure
and prior authorization communication. that standard methods and procedures are used
when making changes to information technology
Automated Dispensing Cabinets—secure stor-
infrastructure, attempting to balance the need for
age cabinets typically located decentrally on patient
change with the potential negative impact changes
care units capable of handling most unit-dose and
can produce.
some bulk (multiple-dose) medications due to stor-
age limitations. Clinical Advisory—a decision-making tool that
is identified for a specific medication. Nursing
Automation—any technology, machine, or device
guidelines are often created as an advisory. An
linked to or controlled by a computer and used to
example would be a suggestion by the pump to the
do work. Automation is designed to streamline and
user to use a 0.22-micron filter when administering
improve the accuracy and efficiency of the medica-
a medication.
tion use process.
Clinical Decision Support (CDS)—providing
Bar Code—a series of vertical lines and spaces of
clinicians or patients with clinical knowledge and
varying widths that encode data to be scanned and
patient-related information, intelligently filtered
decoded through a computer.
or presented at appropriate times, to enhance
Bar Code Medication Administration patient care. Clinical knowledge of interest could
(BCMA)—an inpatient clinical decision support range from simple facts and relationships to best
system to assist caregivers with the five rights of practices for managing patients with specific dis-
medication administration (right patient, right drug, ease states, new medical knowledge from clinical
right dose, right route, and right time). BCMA sys- research, and other types of information.
tems provide warnings if any of the five rights are
Clinical Decision Support System (CDSS)—a
compromised, and many BCMA systems require the
system (computer or otherwise) intended to pro-
nurse to enter an override reason if he/she chooses
vide CDS to clinicians, caregivers, and healthcare
to proceed. In addition, BCMA systems promote
consumers. Automated CDSS are usually just-in-
right documentation (some hospitals call this the
time, point-of-care messages in the form of an
sixth right of medication administration).
alert, reminder, recommendation, or informational
Bar-coding at the Point of Care (BPOC)—a notification regarding a patient. Automated CDS
process in which the patient and various patient systems typically include a knowledge base (which
therapies are documented with a bar code scanner contains stored facts and some method of algorith-
at the bedside. mic logic), an event monitor (to detect data entry
or the storage of data from a laboratory or other
Business Intelligence—an umbrella term that
system), and a communication system to the end
describes the strategic integration of technology
user (unidirectional or bidirectional).
and processes that allow organizations to leverage
their data to make better decisions.

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Clinical Informatics—the scientific study of Data Warehouse—centralized repository of
the effective analysis, use, and dissemination of data from an organization’s individual informa-
information in patient care, clinical research, and tion systems that is organized into integrated
medical education. subject domains for reporting or data mining. Data
warehouses may be implemented with relational or
Clinical Information System—a group of com-
dimensional data models.
puters that run databases and software applica-
tions to effectively provide a comprehensive reposi- Database—a large collection of data organized
tory of patient-specific healthcare information. As a for rapid search and retrieval by a computer.
general term, this might be a laboratory, pharmacy,
Database Query—general term to describe a
nursing documentation, or ordering system.
“search” of a database that returns data for use in
Clinical Pharmacy Technician—a highly skilled reporting or other analyses.
pharmacy technician or “pharmacist assistant”
Dataset—the recommended parameters for each
with advanced training and/or pharmacy technician
medication programmed into the smart pump soft-
certification completed.
ware such as dose, dosing unit, rate, or concentra-
Clinical Reminder—a context-sensitive electronic tion.
prompt to the provider to perform an intervention
Dimensional Database Model—an approach
or procedure, based on the patient’s specific clinical
to designing databases for the purpose of maximiz-
data as applied to a set of logical conditions.
ing end-user friendliness and query performance
Computerized Provider Order Entry as well as to preserve data history. These features
(CPOE)—automated portion of a clinical informa- stand in contrast to the strengths of the relational
tion system that enables a patient’s care provider database model.
to enter an order for a medication, clinical labora-
Dispenser—term that the Department of Health
tory, radiology test, or procedure directly into the
and Human Services Centers for Medicare &
computer. The system then transmits the order to
Medicaid Services uses to specify the pharmacy
the appropriate department, or individuals, so that
and pharmacist. It is assumed that this includes in
it can be carried out.
addition to the dispensing of prescription medica-
Corollary Orders—orders entered as adjuncts tions that the appropriate verifications and patient
to a primary order, e.g., orders for laboratory tests education is provided by the dispenser.
to monitor effects of a medication order, orders for
Downtime—the period of time during which the
special diets in preparation for a medical procedure.
healthcare facility’s computer system is unavailable
Cost of Downtime—associated costs including: and electronic order entry is not possible.
(1) direct costs—staff salary, downtime equipment,
Drug Library—list of medications programmed
lost revenue, downtime supplies, and (2) indirect
in the smart pump software. The library includes
costs—delays in medication delivery, increase in
properties such as name, dose, and concentration
medication errors, staff stress levels, etc.
for each medication listed.
Dashboard—common report format used to
e-Iatrogenesis—patient harm caused at least
quickly evaluate the performance of a business
in part by the application of health information
process. Dashboards commonly use visuals such as
technology.
dials, gauges, or stoplights to represent results.
Electronic Health Record (EHR)—a longitu-
Data Integrity—the accuracy, completeness,
dinal electronic medical record (EMR) of patient
consistency, and validity of data.
health information generated by one or more
Data Mining—broad term that encompasses encounters in any care delivery setting. It contains
numerous methods used to identify patterns and episodes of care across multiple care delivery
relationships in data. Examples of data mining organizations (CDOs) within a community, region,
techniques include neural networks, rule induction, or state.
and genetic algorithms.

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Electronic Medical Record (EMR)—a comput- Health Insurance Portability and Account-
erized legal clinical record created in a CDO, such ability Act (HIPAA)—law enacted in 1996 by the
as a hospital or physician’s office. It is an applica- U.S. Congress in order to protect patient medical
tion environment composed of the clinical data information. Title II of HIPAA, the Administra-
repository (CDR), clinical decision support (CDS), tive Simplification (AS) provisions, requires the
controlled medical vocabulary (CMV), computer- establishment of national standards for electronic
ized provider order entry (CPOE), pharmacy, clinical health care transactions and national identifiers for
documentation, and other ancillary applications. providers, health insurance plans, and employers to
address the security and privacy of health data.
Electronic Prescribing, or e-Prescribing—
refers to the use of computing devices to enter, Health Level Seven (HL7)—an important
modify, review, and output or communicate drug standards development organization for health
prescriptions and medication regimens for patients. information technology (HIT). For detailed informa-
E-Prescribing is one component of CPOE systems. tion, see the HL7 website: http://www.hl7.org
eMAR—electronic medication administration Healthcare Information Technology (HIT)—
record. any computer system designed to automate and/ or
enhance a healthcare process or workflow. HIT can
ePHI—electronically protected health information.
be a small apparatus such as an IV infusion pump
Individually identifiable health information stored
or a glucometer or a departmental information sys-
electronically by healthcare providers.
tem such as a pharmacy or laboratory information
ePrescription—according to CMS, a prescrip- system. It can be an institutional information sys-
tion is not an ePrescription unless it is transmitted tem such as an admissions, discharge, and transfer
electronically in a standard format. Printed paper (ADT) system, which may interface or interoperate
prescriptions and electronic faxes are not consid- with other departmental systems. HIT can also be a
ered to be ePrescriptions by CMS rule. multi-institutional system, such as a regional health
information organization (RHIO), or even a national
Evaluation/Outcomes Measure—post down-
health information network (NHIN).
time review to determine if existing policies and
procedures, planning, and staffing worked, and Human Factors—physical, mental, or behavioral
what needs to be changed. properties of people that may have critical influ-
ence on how people interact with technological
File Architecture—also referred to as the medi-
systems, organizations, or their environment.
cation masterfile, a compilation of interconnected
files and records that contain data elements that Imager—an electronic device similar to a scanner
compose the medication and clinical information that analyzes an image, including linear and two
presented for use in an EHR system. dimensional bar codes, and digitally converts it into
data.
Fitness for Purpose—a property of data that is
appropriate for a given use. In reporting or other Implementation—the execution of a plan that,
data analysis, fitness for purpose is evaluated along when referring to a technology system, generally
dimensions of timeliness and relevancy for the task encompasses requirements analysis, determination
at hand. of project scope, integration plan, user training,
policy development, and delivery.
Formulary—a health system’s specific list of
medications approved for use by its clinicians. Improper Dose Error—administration to the
patient of a dose that is greater than or less than
Hard Limit—a dose that serves as the absolute
the amount ordered by the prescriber or adminis-
limit (high or low) for drug administration by the
tration of duplicate doses to the patient, i.e., one or
pump. Once this hard limit is reached, the dose
more dosage units in addition to those that were
cannot be overridden, serving as a warning to the
ordered.
pump user that the dose needs to be verified prior
to drug administration. Informaticist—someone who applies information
technology to a specific discipline (e.g., pharmacy
informaticist).

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Information Systems (IS)—(1) Computerized which explicit relationships exist. Familiar examples
systems for workflow management such as a phar- of commercial knowledge bases that incorporate
macy computer system, or an information retrieval databases are drug-drug interaction and drug al-
system such as a library. The defining characteristic is lergy alerting systems.
a database and specialized features and functions for
Levels of Downtime—duration of downtime
a dedicated purpose. (2) A department of HIT or com-
that will require different activation of the down-
puter professionals. When designating a department,
time plan to maintain pharmacy operations, for
IS usually stands for Information Services.
example: (1) short duration—up to 2 hours, (2)
Informational Notice—may be a patient-specif- medium duration—2 to 7 hours, and (3) long
ic automated rule, such as an MLM, to inform of a duration—greater than 8 hours.
change in patient status. This type of informational
Linear Symbology—a one-dimensional bar code
notice may be urgent (e.g., to report a change in
consisting of vertical lines and spaces.
renal function) or non-urgent (e.g., to report a
hospital admission of a potential study patient). An Logical Observation Identifiers Names and
informational notice may also be product-specific Codes (LOINC)—a standard to facilitate the
such as a pop-up box during order entry to an- exchange of clinical laboratory results. The Regen-
nounce a look-alike, sound-alike (LASA) drug. strief Institute, Inc., maintains the LOINC database
of about 41,000 terms, and its supporting docu-
Infusion Pump—a device that administers drugs
mentation.
or nutrition to a patient through intravenous, sub-
cutaneous, intramuscular, intrathecal, epidural, or Look-Alike, Sound-Alike (LASA)—a medication
intra-arterial routes. Infusion pumps can administer safety designation to prevent confusion between
fluids in very controlled amounts. drugs with similar spelling or pronunciation.
Integrated Systems—when information systems Maintenance—work that must be done to a soft-
that perform different functions share the same ware program to ensure that the system is updated
database, application space, and often hardware. and accurate.
They are usually provided as a single solution.
Medical Logic Module (MLM)—a rule for an
Integration—in information technology, the Arden Syntax based clinical rules engine. HL7
physical or functional linking of two separate sys- defines a MLM as an encoded clinical rule that
tems in order to achieve a desired new functional- contains enough logic to make a single clinical
ity or capability, often through the use of interfaces. decision. MLMs in use today have been developed
(Note: The definition is still a matter of debate in for many purposes, such as clinical alerts, recom-
the informatics community.) mendations, reminders, informational notices, inter-
pretations, diagnosis, quality assurance functions,
Interfaced Systems—when separate informa-
continuous quality improvement, bio-surveillance,
tion systems (with separate databases) are built to
administrative support, and for clinical research.
communicate with one another. This requires the
development of an interface to normalize informa- Medication Error—any preventable event that
tion for interpretation by both systems. may cause or lead to inappropriate medication
use or patient harm while the medication is in the
Interface—internal communication between two
control of the health care professional, patient or
separate entities (i.e., hardware or software) that
consumer.
allows information and resources to be shared
without affecting how external entities (i.e., a user) Medication Management System—an
interacts with each system. automated system that is often connected to other
healthcare systems, that supports patient safety,
IOM—the Institute of Medicine.
and that improves the quality of care by reducing
Knowledge Base—a collection of stored facts, practice errors and misuse. A medication manage-
rules, algorithms, heuristics, and models for ment system does so by providing access to medi-
problem solving. Knowledge base data may be cations only by authorized personnel and (usually)
organized in a database or even a simple table in only if a validated order exists within the system.

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Medication Masterfile—compilation of records cian, primary provider, or care team to alert them of
that individually contain data elements that com- new information (i.e., abnormal lab result) or tasks
pose the medication information presented for use in need of completion (i.e., unsigned order or note).
in an EHR system.
Omission Error—failure to administer an ordered
Medication Reconciliation—the process of dose to a patient before the next scheduled dose,
identifying the most accurate list of all medica- if any.
tions a patient is taking, including name, dosage,
On Line Analytical Processing (OLAP)—a class
frequency, and route, and using this list to provide
of applications to support complex queries and
correct medications for patients anywhere within
analysis across multiple dimensions. OLAP systems
the health care system. Reconciliation involves
often implement a dimensional data model and are
comparing the patient’s current list of medica-
closely related to data warehouses.
tions against admission, transfer, and/or discharge
orders. On Line Transaction Processing (OLTP)—a
class of applications designed to support transac-
Medication-Use System—a complex system
tion based operational processes such as order
involving multiple individuals, processes and
entry or packaging. OLTP systems often rely on
technology to manage the ordering, verifying, pro-
databases that implement a relational data model.
curement, preparing, distribution, monitoring, and
education of medication therapy. Open Database Connectivity (ODBC)—
standard interface for accessing modern database
Monitoring Error—failure to review a prescribed
systems.
regimen for appropriateness and detection of
problems, or failure to use appropriate clinical or Order Menu—a listing of orders from which
laboratory data for adequate assessment of patient clinicians may select individual orders, organized to
response to prescribed therapy. support a specific purpose, ordering environment,
or type of order.
NCPDP—National Council for Prescription Drug
Programs; an organization that creates and Order Set—compilation of medication and proce-
promotes standards for the transfer of data to and dure orders that can be accessed and ordered from
from the pharmacy services sector of the healthcare a single source in the EHR. These are analogous to
industry. NCPDP is an ANSI-accredited standards paper pre-printed order forms.
development organization that has over 1450
Patient Care Information System (PCIS)—
members representing all areas of pharmacy ser-
technology system used by a health care profes-
vices. NCPDP has developed standards for provider
sional for the provision of care to a patient, either
identification and telecommunication standards
directly through decision support or in a support
for pharmacy claims. It has also developed SCRIPT,
role such as informational storage or management
which consists of multiple standards supporting
of information function. PCIS supports the provision
prescription communication and processing.
of care for patients.
National Council for Prescription Drug Pro-
PDP—Medicare Prescription Drug Plan (PDP) is
grams (NCPDP) Script—is a standard for ambu-
the prescription drug plan that was created with
latory prescription messaging between pharmacies
the Medicare Prescription Drug, Improvement and
and third party payers. The NCPDP standard has
Modernization Act of 2003.
been in use for decades. In 2004, HL7 had started
its own efforts to develop a standard for institu- Personal Health Records (PHR)—an Internet-
tional prescription messaging, and decided to cre- based set of tools that allows people to access and
ate a harmonized mapping between NCPDP’s script coordinate their lifelong health information and
and HL7’s RX messages. Their intention is to ensure make appropriate parts of it available to those who
interoperability of prescription information across need it.
the entire healthcare information environment. Pharmaceutical Care—the responsible provi-
Notification—a patient- and context-sensitive sion of drug therapy for the purpose of achieving
prompt to the ordering provider, attending physi- outcomes that improve a patient’s quality of life.

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Pharmacy Information System (PIS)—a update pharmacy information/automations systems
system that provides pharmacy staff the necessary that were affected during downtime.
application environment to practice the profession
Regional Health Information Organization
of pharmacy; often includes the ordering, procure-
(RHIO)—proposed definition by the Department of
ment, preparation, dispensing, and monitoring
Health and Human Services, BearingPoint, and the
portions of the medication use process.
National Alliance for Health Information and Tech-
Prescriber—the health practitioner who has the nology. A governance entity comprising separate
legal authority for ordering ambulatory medica- and independent healthcare-related organizations
tions. that have come together to improve the quality,
safety, and efficiency of healthcare for communities
Prescribing Error—incorrect drug selection
in which it operates and for which it takes respon-
(based on indications, contraindications, known
sibility to develop transparent, inclusive processes
allergies, existing drug therapy, and other factors),
that enable the interoperable exchange of health
dose, dosage form, quantity, route, concentration,
information in a manner that protects the confiden-
rate of administration, or instructions for use of a
tiality
drug product ordered or authorized by physician (or
other legitimate prescriber); illegible prescriptions Relational Database Model—an approach
or medication orders that lead to errors that reach to designing databases based on mathematical
the patient. set theory. Proper application of the model helps
ensure data integrity is maintained during transac-
Profile—unique set of options and best practice
tions that update, add, or remove data.
guidelines for a specific patient population.
Reminder—an automated rule, such as an MLM,
Protected Health Information (PHI)—this
that suggests the clinician has overlooked or for-
is information about a person that must remain
gotten to perform an action such as documenting a
secure, as defined by Health Insurance Portability
decision, event, or finding.
and Accountability Act (HIPAA).
Reporting—the concise presentation of relevant
Quick Order—a pre-configured order in which
operational or clinical data for decision making or
the components (e.g., medication, dose, route,
performance review purposes.
schedule, amount, number of refills, etc.) are speci-
fied, allowing for faster order entry and limiting RXNORM—a clinical drug nomenclature standard
opportunities for entry errors. These are sometimes produced by the National Library of Medicine.
referred to as order sentences and may be main-
Scanner—an electronic device that analyzes an
tained and standardized across an institution or
object, such as a linear bar code, and digitally
created by individuals as personal quick orders,
converts it into data.
user preferences or preference lists. transcribed
into the receiving systems. Few current ePrescribing Scheduled Downtime—system outage that
installations currently realize this goal. is scheduled for pharmacy information/automa-
tion systems allowing for prospective downtime
Radio Frequency Identification (RFID)—a
planning; most common reasons include planned
computerized chip or tag with an antenna capable
hardware or software upgrades.
of storing data in conjunction with a receiving
module for purposes of product identification or Server—the heart of a network of computers,
tracking. providing a centralized and organized location for
the PIS, database, and application.
Recommendation—an automated rule, such
as an MLM, that suggests a course of action. For Smart Pump—a computerized infusion device
example, a patient-specific dosage or a suggestion that can be programmed to include a specific set
for a laboratory test. Ideally, all recommendations of data.
are evidence-based and institutionally approved.
Soft Limit—similar to hard limits but can be over-
Recovery Period—time period post downtime ridden and a dose can be programmed for delivery.
for entry of data generated during downtime to

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Structured Query Language (SQL)—standard Two-dimensional (2D) Symbology—a bar
language used to query and manage databases. code that may use dots or lines arranged on the
Pronounced “sequel.” vertical and horizontal axes that can contain up to
several thousand characters.
Supply Chain Management—the management
of the pharmaceutical order-to-pay process includ- Unauthorized Drug Error—administration to
ing management of inventory and distribution of the patient of medication not authorized by a
supplies throughout the medication use process. legitimate prescriber.
Switch—a company that provides a communi- Unscheduled Downtime—system outage that
cation network to support claims adjudication, is not scheduled for pharmacy information/automa-
eligibility checking and electronic prescribing for tion systems, resulting in no prospective downtime
pharmacies. planning. Most common reasons include unplanned
hardware or software failures, power outages, and
Symbology—the pattern represented in a bar
extreme weather conditions.
code that encode data and allow it to be con-
verted into information with the use of a scanner Workstation—the computer in the pharmacy that
or imager. A symbology is similar to a computer a staff member uses to interact with the PIS.
language.
Wrong Dosage-Form Error—administration to
Systematized Nomenclature of Medicine the patient of a drug product in a different dosage
Clinical Terms (SNOMED CT)—a comprehensive form than ordered by the prescriber.
clinical terminology, originally created by the Col-
Wrong Drug-Preparation Error—drug product
lege of American Pathologists. For more informa-
incorrectly formulated or manipulated before
tion, see the National Library of Medicine Unified
administration.
Medical Language System website: http://www.
nlm.nih.gov/research/umls/Snomed/snomed_main. Wrong Time Error—administration of medication
Html outside a predefined time interval from its sched-
uled administration time (this interval should be
Technology—anything that is used to replace
established by each individual health care facility).
routine or repetitive tasks previously performed by
people, or which extends the capability of people.

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