A

Access
The ability to obtain needed medical care; often affected by the availability of insurance, cost and/or geographic location

Accountability
An obligation or willingness to accept responsibility for performance

Accountable Care Organization (ACO)
A group of health care providers who provide coordinated care and chronic disease management to improve quality of care

Acute Care Hospital (ACH)
A hospital that provides inpatient medical care and other related services for surgery, acute medical conditions or injuries

Aggregate Data
Data extracted from individual health records and combined to form de-identified information about groups of patients which can be compared and analyzed

Adopt
Install or begin using certified electronic health record technology capable of meeting meaningful use requirements

Adverse Drug Reaction
An undesirable response associated with use of a drug that compromises therapeutic efficacy, enhances toxicity or both

Agency for Healthcare Research and Quality (AHRQ)
Federal agency within HHS focused on improving health care quality, safety, efficiency and effectiveness; supports research and technology assessment, including health IT implementation

Ambulatory Care
All health services provided on an out-patient basis and do not require overnight care

Analytics
The discovery and communication of meaningful patterns in data; refers to the use of specific data to develop in-depth understandings of the workings of the health system

American Recovery and Reinvestment Act (ARRA) of 2009
Included an investment of $59 billion in health care initiatives, including $19 billion in health information technology (IT). The health IT provisions of ARRA are found primarily in Title XIII, Division A, Health Information Technology and in Title IV of Division B, Medicare and Medicaid Health Information Technology, which are known as the HITECH Act

Attestation
Confirmation by a provider that the meaningful use standards have been met

B

Bayou Health
Refers to a group of health plans in which Louisiana’s Medicaid/LaCHIP patients can enroll; each health plan is accountable to DHH and the state

Behavioral Health
An umbrella term that includes mental health and substance abuse

Benchmark
A level of care set as a goal to be attained by a health care provider or organization

Best Practices
The best clinical or administrative practice or approach at the moment, given the situation, the consumer or community needs and desires; the evidence about what works for a particular situation and the resources available

C

Care Coordination

Refers to information-sharing across providers, patients, types and levels of service, sites and time frames to ensure that patients’ needs and preferences are met and that care is efficient and of high quality

Care Coordination Tools

Tools that transmit health information, improve clinical practice and enhance patient-provider relationships

Care Setting

Any facility or office in which an individual receives health care

Case Management

The monitoring and coordination of treatment rendered to patients with specific diagnosis or requiring high-cost or extensive services

Case Manager

The health care professional who coordinates the services necessary to carry out a case management plan

Certified Electronic Health Record Technology (CERHT)

EHR technology certified under the ONC Health IT Certification Program to ensure the technology meets the adopted standards, criteria and other technical requirements to achieve meaningful use

Centers for Medicare and Medicaid Services (CMS)

The federal agency that manages the Medicare, Medicaid and CHIP programs

Chartered Value Exchange (CVE)

Multi-stakeholder collaborative supported by AHRQ to convene providers, payers, patients and purchasers at the local level to improve health care

Children’s Health Insurance Program (CHIP)

Federal-state program that provides health care coverage for uninsured, low-income children who are not eligible for Medicaid

Chronic Disease Management

An integrated care approach to managing illness through screenings, check-ups, monitoring and coordinating treatment and patient education

Claim

An itemized statement of health care services and their costs provided by the hospital, physician office or other health care provider and submitted for reimbursement to the health care insurance plan by either the insured party or the provider

Clinical Data

Data captured during the process of diagnosis and treatment

Clinical Data Repository

A central database that focuses on clinical information

Clinical Decision Support

Interactive computer programs or systems that help clinicians perform complex tasks associated with the care management process

Clinical Quality Improvement

An interdisciplinary process designed to raise the standards of the delivery of preventive, diagnostic, therapeutic and rehabilitative measures to maintain, restore or improve health outcomes of individuals and populations

Clinical Quality Measure

A mechanism used for assessing the degree to which a provider competently and safely delivers clinical services that are appropriate for the patient in an optimal time frame

Clinician

Various types of health care providers; may include, but not limited to, physicians, nurses and allied health professionals

Collaboration

A recognized relationship among different sectors or groups which have been formed to take action on an issue in a way that is more effective and sustainable

Computerized Provider Order Entry (CPOE)

Refers to EHRs as part of larger health IT system to assist with clinical decision support

Consultant

Individuals who have advanced skill sets in a specific content area and provide expert advice, training and support to health care providers and their office staff

Continuity of Care

Process by which the patient and the physician are cooperatively involved in ongoing health care management toward the goal of high quality, cost-effective medical care

Continuity of Care Document (CCD)

An XML-based markup standard intended to specify the encoding, structure and semantics of a patient summary clinical document for exchange; provides a means for a provider, system or setting to aggregate patient data and forward it to another provider, system or setting to support the continuity of care

Continuum of Care

Refers to an integrated system of care that guides and tracks patients over time through a comprehensive array of health services spanning all levels of intensity of care

Core Measures

Specific clinical measures that, when viewed together, permit a robust assessment of the quality of care provided in a given focus area

Cost of Care

Measure of the total health care spending, including total resource use and price, by payer or consumer, for a health care service or group of health care services associated with a specified patient population, time period and units of clinical accountability

Critical Access Hospital (CAH)

A hospital certified under a set of Medicare Conditions of Participation (CoP) which are structured differently than the acute care hospital CoP

D

Data

Information processed by a computer

Database

An electronic list of information that can be sorted and/or searched

Data Capture

Refers to entering a specific data element into the specified health IT application versus the paper chart

Data Integrity

The extent to which health care data are complete, accurate, consistent and timely

Data Mining

The process of extracting information from a database and then quantifying and filtering discrete, structured data

Data Source

Source from which data is obtained for measurement

Data Warehouse

A database that makes it possible to access information from multiple databases and combine the results into a single query and reporting interface (see also Clinical Data Repository)

Denominator

The number below the line in a fraction. Denotes how many parts make up the whole

Direct Exchange

Electronic transmission of health information through a direct connection between the EHR systems of health care providers without the use of a health data intermediary

Direct Messaging

Similar to secure web email but designed specifically for the secure exchange of patient health information by authorized health care providers or organizations through an HIE; a requirement for Stage 2 Meaningful Use

Direct Patient Care

Any activities by a health care professional involving direct interaction, treatment, administration of medications or other therapy or involvement with a patient

E

Effectiveness of Care

Refers to health care services that are of proven value and have no significant tradeoffs; health care services are supported by evidence of efficacy

Efficiency of Care

Measure of the relationship of the cost of care associated with a specific level of performance measured with respect to quality

eHealth Exchange

(formerly the Nationwide Health Information Network, or NHIN)

A growing community of exchange partners who share information under a common trust framework and a common set of rules; designed to help improve the health and welfare of Americans through health information exchange that is trusted, scalable and enhances the quality of care and health outcomes by supporting comprehensive longitudinal health records

Encounter

A contact between and individual and the health care system for a health care service or set of services related to one or more medical conditions

End of Life Care

Care that helps those with advanced, progressive, incurable illness to live as well as possible until death

ED Utilization

Refers to the use of a hospital’s emergency department (ED) or emergency room (ER)

e-Health

The secure use of electronic information and communications technologies in support of health care delivery, such as electronic health records, electronic prescribing, health information exchange and telemedicine

Electronic Health Record (EHR)

Digital record of health-related information for an individual – also known as an electronic medical record (EMR)

Electronic Prescribing (e-Prescribe)

The electronic transmission, not including fax, of prescriptions to and from pharmacies and point of care

EHR Reporting Period

The period in which an Eligible Professional or Eligible Hospital demonstrates meaningful use

Eligible Hospitals (EHs)

Hospitals that are eligible to receive Medicaid and/or Medicare EHR incentive payments from CMS

Eligible Professionals (EPs)

Health care professionals who are eligible to receive Medicaid and/or Medicare EHR incentive payments

Emergency Medical Condition

An illness, injury, symptom or condition requiring immediate medical attention/treatment to avoid severe harm

Equity in Health

Refers to fairness in health care delivery, meaning peoples’ needs guide the distribution of opportunities for well-being

Evidence-Based Practice

Applying the best available research, or evidence, when making decisions about health care; a method of improving and evaluating patient care

Exclusion

Refers to a CMS provision that allows providers to report that specific meaningful use measures do not apply to them because have no patients, or no or insufficient number of actions that would allow calculation of the meaningful use measure

F

Fee-for-Service

A traditional method of paying for medical services under which doctors and hospitals are paid for each service they provide

Federally Qualified Health Centers (FQHCs)

Safety net providers such as community health clinics and public housing centers that provide health services regardless of the ability to pay and are funded by the government

G

H

Health Care Consumer

Refers to anyone who uses, has used or may use any health or health-related service

Health Disparities

Differences between groups of people that may affect how frequently a disease affects a group, how many people get sick, or how often the disease causes death

Health Information

Information regarding medical, clinical or health-related subjects that individuals may use to make appropriate health decisions

Health Information Exchange (HIE)

The electronic sharing of health-related information among organizations via a secure network

Health Insurance Portability & Accountability Act (HIPAA) of 1996

Sets standards and rules to ensure the security and privacy of personal health information

Health Information Technology for Economic and Clinical Health (HITECH) Act

Provides HHS with authority to establish programs to improve health care quality, safety and efficiency through health IT measures such as EHRs and HIEs

Health IT

Health information technology - the use of computer hardware and software to privately and securely store, retrieve, and share patient health and medical information

Health Level 7 (HL7)

A standards-developing organization that provides 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

Health Outcome

Refers to the result of the health care a person receives

Healthcare Effectiveness Data and Information Set (HEDIS)

A set of measures used by many U.S. health plans to evaluate performance on important dimensions of care and service

Home Health Care

Health care services a person receives at home

Hospice

Services to provide comfort and support for persons in the last stages of a terminal illness

I

Indicator

A quantitative or statistical measure or gauge for monitoring clinical care

Informed Decision-Making

Process designed to help patients understand the nature of the disease or condition being addressed, the clinical service being provided and the impact of their own care preferences to enable them to actively participate in decision-making

Interoperability

The ability of two or more systems to communicate, or exchange, useable information; does not mean the same thing as health information exchange

Incentive Payments

A program established in ARRA to pay incentives to certain classes of eligible Medicare and Medicaid professionals who adopt and become meaningful users of EHRs

J

Joint Commission

An independent, not-for-profit organization that provides health care accreditation and related services to support performance improvement within health care organizations

K

L

Louisiana Children’s Health Insurance Program (LaCHIP)

Provides health coverage to uninsured children up to age 19; a no-cost health program that pays for hospital care, doctor visits, prescription drugs and more (See also Children’s Health Insurance Program)

Louisiana Department of Health and Hospitals (DHH)

State agency focused on protecting and promoting health and ensuring access to medical, preventive and rehabilitative services for Louisiana residents

Louisiana Immunization Network for Kids Statewide (LINKS)

Web application that allows users to conveniently search for patients in its central registry and view the patient’s vaccination record; also allows authorized users to add and edit patient records and vaccination records as well as maintain facility, physician and lot number data

Louisiana Physician Orders for Scope of Treatment (LaPOST)

A document by which a person with a serious, advanced illness may communicate his/her wishes concerning medical treatment and end-of-life care with a physicians order; approved by Louisiana Legislature in 2010 as Act 954

Long-Term Care

Services provided in institutional settings such as nursing homes

M

Managed Care

A health care delivery system designed to control access to and use of health care services to limit costs and to improve quality

Mandatory Reporting

A system under which physicians or other health care professionals are required by law to inform health authorities when a specified event occurs

Master Patient Index (MPI)

An electronic medical database that holds information on every patient registered at a health care organization; stores information such as name, date of birth, gender, race, social security number, address and medical history to provide a clear and complete view of an individual patients and a large-scale view of the organization’s demographics

Meaningful Use (MU)

Sets specific objectives that Eligible Professionals and Eligible Hospitals must achieve to qualify for the CMS EHR Incentive Programs; means providers must show they are using certified EHR technology in ways that can be measured significantly in quality and quantity

Measure

Tools that show whether the standards for prevention, screening and management of health conditions are being met

Measure Set

A collection of measures with a common purpose and developer

Medication Error

Any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient or consumer

Model of Care

A concept that provides an outline of how to plan current and future facility and clinical service; used to help guide and direct a patient’s experience within a health care system

N

National Committee for Quality Assurance (NCQA)

An accrediting body for PCMH recognition; private, not-for-profit organization dedicated to improving health care quality

National Quality Strategy (NQS)

A nationwide effort to provide direction for improving health and health care in the U.S.; guided by three aims focused on better care, healthy people and communities and affordable care

Numerator

The number above the line in a fraction. Denotes the number of parts out of the whole that are being counted.

O

Office of the National Coordinator for Health Information Technology (ONC)

Agency within HHS that supports the adoption of health IT and promotes nationwide health information exchange to improve health care

P

Palliative Care

Appropriate and compassionate care for patients with serious, advanced illness

Patient-Centered Care

Care based on a patient’s cultural traditions, personal preferences and values, family situation and lifestyle; designed to ensure that transitions between difference health care providers and care settings are coordinated and efficient

Patient-Centered Medical Home (PCMH)

Refers to a health care setting where patients receive comprehensive primary care services; have an ongoing relationship with a primary care provider who directs and coordinates their care; have enhanced access to non-emergent primary, secondary and tertiary care; and have access to linguistically and culturally appropriate care.

Patient Engagement

A connection between the patient and his/her health care provider; describes a trusted relationship in which patients and their families are empowered and active in health care decisions

Patient Portal

A secure online website designed to give patients 24-hour access to their personal health information from any location with an internet connection; secure username and password required for access

Patient Privacy

Refers to the rights of patients to determine when, how and to what extent their personal health information is shared with others

Patient Safety

The avoidance of injuries to patients from the care that is intended to help them

Patient Volume

Under the Medicaid EHR program, the minimum participation threshold where the numerator is the total number of Medicaid patients or needy individuals treated in any 90-day period in most recent calendar year preceding the reporting and the denominator is all patient encounters in the same 90-day period.

Pay-for-Performance

Refers to a health care payment system in which providers receive incentives for meeting or exceeding quality benchmarks

Payer

In health care, generally refers to entities other than the patient that finance or reimburse the cost of health services; usually refers to insurance carriers, other third-party payers or health plan sponsors such as employers or unions

Payment Reform

Seeks to improve current mechanisms for reimbursing providers by focusing on provider quality

Performance Measure

Provides an indication (e.g., rate, ratio, index, percentage) of an organization's/or provider's ability to provide care most likely to ensure a good patient outcome

Personal Health Record (PHR)

An electronic application through which individuals can maintain and manage their health information in a private, secure and confidential environment

Physician Orders for Life-Sustaining Treatment (POLST)

An approach to improving end-of-life care planning based on conversations between patients, loved ones and health care professionals designed to ensure that seriously ill or frail patients can choose the treatments they do or do not want and that their wishes are documented and honored

Physician Quality Reporting System (PQRS)

(formerly called the Physician Quality Reporting Initiative, or PQRI) A voluntary quality reporting program that provides an incentive payment to identified individual eligible professionals and group practices who satisfactorily report data on quality measures for covered Physician Fee Schedule (PFS)

Point of Care

Refers to the point in time at which health care products and/or services are delivered

Population Health

The health outcomes of a group of individuals, including the distribution of such outcomes within the group; refers to an approach to health that aims to improve the health of an entire population

Preventive Care

Medical care focused on prevention and early-detection of disease or illness; includes age and gender appropriate lifestyle changes, immunizations, vaccinations, physical exams, screening tests and other measures; services that help patients stay healthy

Primary Care Provider (PCP)

A health care provider who provides, coordinates or helps a patient access a range of health care services; usually a doctor, but may be a physician assistant, clinical nurse specialist or nurse practitioner

Public Health

The science dealing with the protection and improvement of community health by organized community effort

Purchaser

In health care, refers to an individual or organization that buys health care services

Q

Quality of Care

The degree to which delivered health services meet established professional standards and judgments of value to the patient; a measure of performance of safety, timeliness, effectiveness, efficiency, equity and patient-centeredness

Quality Improvement

Refers to comprehensive efforts to improve health care and the health of individuals and populations

Quality Measurement

The process of collecting data to assess performance conducted at a single point in time or repeated over time

Quality Metric

A measure that allows a user to quantify the quality of a selected aspect of care by comparing it to a criterion; used to provide a more complete overview of the health care quality status of health care providers and organizations

Query

The process of making a logical inquiry or request from a database

R

Record Locator Service (RLS)

Electronic index of patient identifying information that directs providers in an HIE to the location of patient health records held by providers and group purchasers

Regional Extension Center (REC)

Established by the HITECH Act to provide education, outreach and technical assistance to help primary care providers adopt and meaningfully use certified EHR technology

Reimbursement

The process by which health care providers receive payment for their services

Rural Health Clinic (RHC)

A federally qualified health clinic certified to receive special Medicare and Medicaid reimbursement as a strategy to increase rural Medicare and Medicaid patients’ access to primary care services

S

Safety Net

In health care, term refers to health care providers who deliver services to patients regardless of their ability to pay

Security

The physical, technological, and administrative safeguards used to protect individually identifiable health information

Shared Decision-Making

Occurs when a patient and his/her health care provider openly communicate about the options, benefits, outcomes and risks of available treatment and reach a plan based on medical evidence, the patient’s values and the doctor’s advice

Specialist

Refers to a physician who focuses on a specific area of medicine to diagnose, manage, prevent or treat certain types of symptoms or conditions

Stakeholder

Refers to persons or groups that have a vested interest in health care delivery, quality, safety, outcomes, improvement and costs

Standard of Care

The expected level and type of care provided by the average caregiver or health care provider under a certain given set of circumstances

Standardized Measures

Nationally-recognized criteria for evaluating the quality of health care provided to patients

Summary of Care Record

A record that includes, at a minimum, diagnostic test results, problem list, medication list and medication allergies; eligible hospitals should also include procedures in this record

Surveillance

Systematic, ongoing collection, collation and analysis of health-related information that is communicated in a timely manner to all who need to know which health problems require action within a community

Syndromic Surveillance

Surveillance using health-related data that precedes diagnosis and signals a sufficient probability of a case or an outbreak to warrant a further public health response

T

Telehealth

The use of telecommunications technologies and electronic information to support long-distance clinical health care, patient and professional education or public health and health administration

Third-Party Reporting

For the EHR Incentive Programs, CMS implemented functionality that allows Eligible Providers to designate a third party to register and attest on his/her behalf

Transition of Care

A transfer of a patient from one clinical or care setting to another

U

Underinsured

People who have health insurance but who face out-of-pocket health care costs or limits on benefits that may affect their ability to pay for services or access health care services

Uninsured

People who lack public or private health insurance

Unique Patient

Refers to a Medicare or Medicaid patient seen during the EHR reporting period

Upgrade

Expand the available functionality of certified EHR technology capable of meeting meaningful use requirements at the practice site, including staffing, maintenance, and training

U.S. Department of Health and Human Services (HHS)

Federal agency that oversees CMS

V

Value-Based Health Care

Describes a health care management strategy focused on creating high-quality and high-value care while reducing costs; designed to remove barriers and encourage patients/consumers to pursue healthy lifestyles

Value Set

A list of specific clinical terms and the codes that correspond with them; defines each of the clinical terms in the elements of a quality measure

Volume-Based Health Care

Describes a health care system based on fee-for-service reimbursement

W

Work Flow

A repeatable pattern of activity enabled by the organization of resources, defined roles and information into a process that can be documented and learned; work flow improvements for health care providers are designed to lessen the burden of providing health care and to lead to greater overall health care quality

X

Y

Z