Healthcare IT Acronyms & Terms
Healthcare IT Alphabet Soup
A dynamic list of the most common acronyms and terms that Health IT, Health Information Managers, Payers, and Providers should know.
To work in health tech requires you to be bilingual (at minimum). Not only must you be fluent in your native tongue, but you must also speak the “Language of Health Tech,” which is comprised of innumerable 3- and 4-letter acronyms. Many of these acronyms become so well-known they’ve become their own word. (Here’s looking at you, HAPI on FHIR!)
It doesn’t matter if you’re new to the world of healthcare IT, being fluent in the Language of Health Tech acronyms, acts and associations is no easy task.
Reducing barriers to information is one of Smile’s core purposes. Technical or acronym-heavy jargon can be considered as one of those barriers. While we love how much time it saves to say “FHIR” instead of “Fast Healthcare Interoperability Resource,” there’s no doubt that all these acronyms can be confusing for people trying to learn more about healthcare interoperability.
To remove any ambiguity from the commonly used Health IT acronyms we have composed this Glossary of Terms. We hope that this resource will help you to navigate the health IT waters more efficiently and from now on, you’ll look at the acronyms as optimized shortcuts to your health IT comprehension as opposed to a hindrance.
DATA TERMS FOR DEVELOPERS
Application Programming Interfaces
An API is a set of requirements for accessing and manipulating data that is stored on a website or server. It enables programmers to quickly assemble applications by sharing and reusing the same code. APIs are especially useful for improving the electronic exchange of healthcare data.
The use of an open, standardized application programming interface (API) can reduce the amount of time needed to develop software that connects two disparate health information systems. A unified API allows developers to create applications that incorporate data from multiple disparate EHR systems without having to rewrite their programs for each new EHR computer platform.
CMS Blue Button 2.0 is a developer-friendly standards-based API for building tools and services that can give people with Medicare access to their data.
Clinical Data Repository
A Clinical Data Repository (CDR) is a database that consolidates and holds a patient’s clinical data from various clinical sources. The data could include patient demographics, radiology images, diagnoses, and admissions.
Clinical Quality Language
Clinical Quality Language (CQL) is a human-readable language standard structured enough to simplify the electronic sharing and manipulation of healthcare data. CQL logic is valuable in
Clinical Decision Support (CDS) and Electronic Quality Measures (eCQM) reporting, as it standardizes and integrates data across different systems.
Diagnosis-Related Group Codes
Medicare and health insurers use Diagnosis-Related Group codes (DRG) to categorize the cost of patients’ hospital stays to determine reimbursements. DRGs are comprised of other codes, including International Classification of Diseases, Tenth Revision (ICD-10) and Current Procedural Terminology (CPT), that are based on diagnoses, procedures, and patient demographics.
Electronic Health Record
An Electronic Health Record (EHR) is the shareable, accessible collection of a patient’s health information, from all practices and facets of care. It provides a longitudinal record of a patient’s health.
Electronic Medical Record
An Electronic Medical Record (EMR) is the digital form of a patient’s chart that was previously kept on paper. An EMR includes a patient’s past medical history, visit summaries, demographics, insurance and medications within one practice.
Explanation of Benefits
An Explanation of Benefits (EOB) is a statement a health plan sends to a patient that shows the health care services received. It is not a bill, but instead a way for a patient to know how much their provider charged for services, what the health plan covers and what it paid, and any difference the patient owes, including deductibles and copays.
Fast Healthcare Interoperability Resources
FHIR is a standardization used to model, exchange and access healthcare information. Also known as the "Exchange Layer," FHIR provides a common language for all stakeholders in the healthcare system — providers, hospitals, insurers and patients — to access health data through an interoperable system.
Health Level Seven
Health Level Seven (HL7) is a Standards Development Organization (SDO) responsible for creating and maintaining a number of healthcare standards, including FHIR. HL7 standards are developed by volunteers under an ANSI accredited process. Many organizations and individuals are members of HL7, including Smile CDR.
10th Version of International Statistical Classification of Diseases and Related Health Problems
International Classification of Diseases, Tenth Revision (ICD-10) is a billing code that describes a patient’s diagnosis. ICD-10 codes are used worldwide to identify health and disease trends.
An implementation guide (IG) is a set of rules about how FHIR resources should be used. It describes how a healthcare provider must implement a standard into a system. The ultimate goal of an IG is to provide a good set of instructions so that any organization can implement the standard using the same steps.
Logical Observation Identifiers Names and Codes
Logical Observation Identifiers Names and Codes (LOINC) is a standard, or common language, that identifies health measurements, observations, and documents. LOINC includes laboratory and clinical data and makes it possible for systems to recognize and aggregate data from disparate sources.
Medical Record Number
A Medical Record Number is the unique number identifier given to a patient by a healthcare organization.
Medicare Savings Account Plan
A Medicare Medical Savings Account (MSA) plan is a type of Medicare Advantage plan that combines a high-deductible health plan with a medical savings account.
Master Data Management
Master Data Management (MDM) is the process or discipline of maintaining a single source of truth for enterprise data. This means that a system exists to ensure the uniformity, accuracy, and consistency of an organization’s shared data assets. MDM is crucial for healthcare interoperability to exist. Without MDM, patient records risk duplication, deletion, or deadly errors.
Personal Health Information or Protected Health Information
Personal or Protected Health Information (PHI) is the information a healthcare professional uses to identify an individual. Information could include: patient name, address and contact information, medical histories, and lab results. This information must be kept private, according to HIPAA.
Patient-Reported Outcome (PRO) is information directly reported by the patient, and not interpreted by a medical doctor or nurse. It could include information related to quality of life, mental health, and perceived efficacy of treatment. PROs can provide a clearer picture of the quality of care a patient receives. By tracking and communicating PROs, health care organizations can help patients make difficult health decisions or to accurately set their expectations.
Systematized Nomenclature of Medicine – Clinical Terms
Systematized Nomenclature of Medicine - Clinical Terms (SNOMED CT) is a comprehensive, multilingual health care terminology resource with scientifically validated clinical content. By using SNOMED CT, clinicians can record data accurately and consistently.
USCDI or US Core
United States Core Data for Interoperability
USCDI is an implementation guide (IG) that was initially adopted as a standard in the ONC 21st Century Cures Act Final Rule. USCDI is a system of standards and processes that will allow health data systems to exchange information with each other.
ORGANIZATIONS, GROUPS & ALLIANCES
Council for Affordable Quality Healthcare®
Founded in 1998, CAQH is a not-for-profit collaborative alliance of the nation’s leading health plans and networks. CAQH streamlines the credentialing process by gathering credentialing information on healthcare practitioners and making that information available to health plans.
Convened in 2016, the mission of CARIN Alliance is to make it easier for people to access more of their digital health information. Its members include consumer advocates, providers, plans, consumer-facing digital health apps, and more.
The Da Vinci Project is a private sector initiative comprised of industry leaders and health IT technical experts working together to accelerate the adoption of HL7® FHIR® as the standard to support and integrate value-based care (VBC) data exchange.
Healthcare Information and Management Systems Society
The Healthcare Information and Management Systems Society (HIMSS) is the world’s largest non-profit health IT organization. Dedicated to improving health care in quality, safety, cost-effectiveness and access through the best use of information technology and management systems, HIMSS is especially known for their annual conference.
National Committee for Quality Assurance
The National Committee for Quality Assurance (NCQA) is a nonprofit organization that measures 412 medicare advantage plans, 171 Medicaid, and 438 commercial plans (HMO, POS, PPO by state).
GOVERNMENT ACTS & ENTITIES
Affordable Care Act
The Affordable Care Act is a US healthcare reform law enacted in 2010 aimed in part at supporting new care delivery models to lower the cost of care.
Centers for Medicare and Medicaid Services
The Centers for Medicare & Medicaid Services, CMS, is part of the Department of Health and Human Services (HHS). CMS administers the Medicare program and partners with states to administer Medicaid and the Children’s Health Insurance Program (CHIP). CMS also oversees state and federal health insurance marketplaces and enforces compliance with administrative simplification requirements.
Health Insurance Portability and Accountability Act of 1996
The Health Insurance Portability and Accountability Act (HIPAA) is a federal law that requires the creation of national standards to protect sensitive patient health information from being disclosed without the patient’s consent or knowledge.
Office of the National Coordinator for Health Information
The Office of the National Coordinator for Health Information (ONC) coordinates nationwide efforts to implement and use the most advanced health information technology. The ONC also establishes expectations for data sharing.
HEALTHCARE DELIVERY METHODS & RATINGS
Alternative Payment Model
An Alternative Payment Model (APA) is a payment approach that gives added incentive payments to provide high-quality and cost-efficient care. APMs can apply to a specific clinical condition, a care episode, or a population.
Fee-for-service (FFS) is a method in which doctors and other healthcare providers are paid for each service performed. Examples of services include tests and office visits.
Federally Qualified Healthcare Center
A Federally Qualified Health Center (FQHC) is a nonprofit health care organization that delivers primary care services to medically underserved populations. FQHCs receive special recognition and federal funding through the Health Resources and Services Administration (HRSA), which is an agency of the US Department of Health and Human Services.
Healthcare Effectiveness Data and Information Set
The Healthcare Effectiveness Data and Information Set (HEDIS) is a set of standardized performance measures designed to help rate and compare health plan performance. HEDIS Measures relate to many significant public health issues, such as cancer, heart disease, smoking, asthma, and diabetes.
HEDIS Measures Include:
- Effectiveness of Care
- Access/Availability of Care
- Experience of Care
- Utilization and Risk-Adjusted Utilization
- Health Plan Descriptive Information
- Measures are reported using Electronic Clinical Data Systems.
Integrated Delivery Network
Integrated delivery networks are groups of healthcare providers that have aligned to deliver high-quality patient care through a single organization. They include physicians, hospitals, physical therapists, lab technicians and other specialists who work as a team to deliver patient-centered care. In addition to the primary goal of improving patient care, these networks work together to lower costs and ensure better access to healthcare.
Medicare Star Rating
Medicare health insurance plans get a star rating from the CMS based on how well they perform on certain measures. It is intended to rate the quality of individual doctors, hospitals and nursing homes. While the ratings have no effect on payments, they do have implications for marketing, recruitment and overall reputation. Higher Star Ratings translate into more members and increased revenues.
The star ratings are calculated by the CMS based on information submitted to them by the health care providers. The data comes from various sources: survey results, death rates, patient complaints and safety violations.
A rating of one star indicates poor performance, whereas a rating of five stars indicates excellent performance.
Value-Based Care is a healthcare delivery model focused on outcomes and value for patients. Value is determined by the cost it takes to achieve the outcome the patient desires. This framework, based on the research of Harvard professor Michael Porter, includes six key elements:
- Organize Care Around Medical Conditions
- Measure Outcomes & Cost for Every Patient
- Aligning Reimbursement with Value
- Systems Integration
- Geography of Care
- Information Technology.