The healthcare industry, and especially healthcare information technology, is constantly evolving and reinventing itself. As a result, terminology changes or becomes more specific on a regular basis. Below are some current common terms—and we’ll update this page occasionally as language develops around new initiatives.
Accountable Care Organization (ACO)
ACOs are groups of physicians, hospitals, and other health care providers that work together to coordinate high quality care for their patients. In some instances, ACO providers contract with payers to accept risk for not meeting goals or to be rewarded for exceeding goals.
Admissions, Discharges, Transfers (ADT)
An ADT system sends automatic notifications or alerts from hospitals to primary care practices and/or care managers when a patient has an admission, discharge, or transfer. Its intent is to improve the timely flow of information needed when a patient is transitioning to care in another setting or in the community.
Advancing Care Information (ACI)
This term refers to the Medicare Merit-based Incentive Payment System (MIPS) performance category focused on use of electronic health records. It replaces the meaningful use program for Medicare physicians.
Affordable Care Act (ACA)
ACA is the shortened term for the Patient Protection and Affordable Care Act of 2010.
Application Programming Interface (API)
In computer programming and as it relates to electronic health records, an API is a set of programming protocols established for multiple purposes and related to meaningful use measures associated with Stage 3 Electronic Access and Coordination of Care through Patient Engagement. It is a technology that allows one software program to access the services provided by another software program. APIs may be enabled by a provider or provider organization to provide the patient with electronic access to their health information through a third-party application with more flexibility than is often found in other “patient portals.”
Attestation is the process of successfully demonstrating Meaningful Use for an EHR Incentive Program.
In a health home, care manager oversees and provides access to all of the services an individual needs to assure that they receive everything necessary to stay healthy, out of the emergency room, and out of the hospital.
Clinical Document Architecture (CDA)
The CDA is a flexible markup standard that defines the structure of certain medical records, such as discharge summaries and progress notes, to better exchange information between providers and patients.
Clinical Quality Measure (CQM) Aligned Population Health Reporting (CALiPHR)
CALiPHR is a technology designed to calculate electronic clinical quality measures (eCQMs) at a provider, practice, payment arrangement, and community level to support incentive and value- based payment programs.
Collaborative care is an approach to healthcare with the goal being to improve overall care, patient outcomes and experience, and affordability by integrating primary care with mental health/specialist treatment to achieve a patient-centered medical home.
Comprehensive Primary Care Plus (CPC+)
This term refers to an advanced primary care medical home model that rewards value and quality by offering an innovative payment structure to support primary care practices to improve quality, access, and efficiency. As the term relates to either the EHR Incentive Programs, states are encouraged to consider aligning their clinical quality measurement (CQM) initiatives with CPC+.
Consolidated Clinical Document Architecture (C-CDA)
The HL7 C-CDA standard is used in the context of EHR certification and Meaningful Use. It contains a library of CDA template standards and represents a unified implementation guide for nine common electronic clinical documents.
Consumer Assessment of Healthcare Providers and Systems (CAHPS)
A family of survey instruments, each is designed to ask consumers and patients to report on and evaluate their experiences with health care. The surveys focus on aspects of quality that consumers are best qualified to assess, such as the communication skills of providers and ease of access to health care services. The acronym “CAHPS” is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ), an organizational unit with HHS.
Continuity of Care Document (CCD)
Built using HL7 Clinical Document Architecture elements, the document contains data defined by the ASTM Continuity of Care Record and is used to share summary information about a patient within the broader context of the personal health record.
Current Procedural Terminology (CPT)
The CPT is a series of alpha-numeric codes used to document medical treatment on claims for payment. It is the HIPAA standard code set for medical, surgical, and diagnostic services and is maintained by the American Medical Association.
Delivery System Reform Incentive Program (DSRIP)
In April 2014, CMS approved New York’s application for an $8 billion Medicaid waiver intended to help achieve the Triple Aim of improved care, enhanced quality, and reduced costs. Most of the waiver funding ($6.4 billion) will be allocated to the Delivery System Reform Incentive Payment (DSRIP) program, which has the overall goal of reducing avoidable hospitalizations in the State by 25% within its five-year lifespan. DSRIP allows provider collaborations called Performing Provider Systems (PPSs) to receive bonus payments if they can reach specific performance benchmarks. These benchmarks will be measured for a specific population of Medicaid and uninsured persons attributed to each PPS. Providers will be able to choose from a menu of 44 projects that aim to create system transformation, improve clinical services, and address population-wide health issues. DSRIP funds are expected to be allocated to PPSs starting in Spring 2015.
Direct Exchange (Clinician-to-Clinician Exchange)
Direct Exchange allows for the sending of patient records directly from one EHR to another EHR (point-to-point). This can be used in transitions of care (hospital discharge, referrals, home health, Long Term Care (LTC), etc.), and may also be used for lab ordering, results delivery, sending records to patients, and physician alerts.
Direct Secure Messaging (DSM)
DSM is a standard to facilitate secure electronic communication of patient-related data between health care providers and health care information technology systems.
Electronic Clinical Quality Measure (eCQM)
An eCQM uses data from electronic health records (EHRs) and/or health information technology systems to measure health care quality. They are considered an improvement over traditional quality measures because the work to gather the data from medical charts is very resource intensive and subject to human error. Quality measures may be used to determine if a provider is making meaningful use (MU) of an EHR system.
Electronic Health/Medical Record (EHR/EMR)
An EHR is an electronic version of a patient’s medical history, maintained by a provider over time. It includes key administrative clinical data relevant to a patient’s care, such as demographics, past medical history, progress notes, problems, medications, vital signs, laboratory data and radiology reports. Its purpose is to automate access to information to streamline a clinician’s workflow and support other care-related activities through various interfaces.
Electronic Protected Health Information (ePHI)
This term refers to any protected health information covered under the Health Insurance Portability and Accountability Act (HIPAA) of 1996 security regulations that is produced, saved, transferred, or received in an electronic form.
Fast Healthcare Interoperability Resources (FHIR)
FHIR is an interoperability standard for electronic exchange of health care information developed by HL7. It provides software development resources and tools for administrative concepts such as patients, providers, organizations and devices, as well as a variety of clinical concepts including problems, medications, diagnostics, care plans and financial issues, among others. See also HL7.
Federally Qualified Health Center
A FQHC is a community-based health care provider that receives funds from the federal Health Resources & Services Administration within HHS to provide primary care services in underserved areas. It may be a community health center, migrant health center, health care program for the homeless or health center for residents of public housing and must meet stringent requirements, including providing care on a sliding fee scale based on ability to pay. Eligible Professionals working in FQHCs qualify for Medicare and Medicaid EHR Incentive Program payments if they meet “needy encounters” criteria. Defining legislation appears in 42 USC § 1396d (I)(2)(B).
Healthcare Effectiveness Data and Information Set (HEDIS)
HEDIS is a tool used by more than 90 percent of America’s health plans to measure performance on important dimensions of care and service. Entrusted to the NCQA, the measurement development process has expanded in size and scope to include measures for physicians, preferred provider organizations, and other entities.
A Health Home is a care management service model whereby all of an individual’s caregivers communicate with one another so that all of a patient’s needs are addressed in a comprehensive manner. This is done primarily through a “care manager” who oversees and provides access to all of the services an individual needs to assure that they receive everything necessary to stay healthy, out of the emergency room, and out of the hospital. Health records are shared among providers so that services are not duplicated or neglected. The health home services are provided through a network of organizations—providers, health plans, and community-based organizations. When all the services are considered collectively, they become a virtual “Health Home.”
Health Information Exchange (HIE)
An HIE allows doctors, nurses, pharmacists, other health care providers and patients to appropriately access and securely share a patient’s vital medical information electronically to improve the speed, quality, safety and cost of health care. There are three key forms: direct exchange of information between providers, query-based exchange so providers can find or request information about a patient from another provider, and consumer-mediated exchange so patients can aggregate and control the use of their health information among providers.
Health Information Organization (HIO)
This term refers to government-led non-profit health organizations that provide information about the American Recovery and Reinvestment Act of 2009 as it pertains to electronic health record (EHRs) development for incentive payments. They assist providers in the interoperability of EHRs for meaningful use information exchanges.
Health Information Service Provider (HSP)
An organization that provides RHIOs with technical services, such as software, hardware, support services, and clinical/quality services that facilitate the secure exchange and use of health information.
Health Information Technology (HIT)
This term refers to health information management across computerized systems and the secure exchange of health information between consumers, providers, payers, and quality monitors.
Health Information Technology Advisory Committee (HITAC)
This committee was established in the 21st Century Cures Act of 2016. The HITAC reports to the Office of the National Coordinator for Health Information Technology (ONC) and recommends policies, standards, implementation specifications, and certification criteria, relating to the implementation of a health information technology infrastructure, nationally and locally, that advances the electronic access, exchange, and use of health information.
Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009
This law was enacted as part of the American Recovery and Reinvestment Act to promote the adoption and meaningful use of health information technology.
Health Insurance Portability and Accountability Act (HIPAA) of 1996
Public Law 104-191 provides, among other things, data privacy and security provisions for safeguarding medical information.
Health Level Seven International (HL7)
This term refers to the non-profit, American National Standards Institute (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.
Home and Community-Based Services (HCBS)
This term relates to opportunities for Medicaid beneficiaries to receive services in their own home or community rather than institutions or other isolated settings. With federal state plan or waiver approval, HCBS programs serve a variety of targeted populations, such as people with intellectual or developmental disabilities, the elderly and those with physical disabilities, and persons with mental illness.
Information Technology (IT)
This term refers to the application of computers to store, study, retrieve, transmit, and manipulate data, or information, often in the context of a business or other enterprise.
HIMSS defines interoperability as the “ability of health information systems to work together within and across organizational boundaries in order to advance the effective delivery of healthcare for individuals and communities.”
Logical Observation Identifiers, Names and Codes (LOINC)
The LOINC is a database and universal standard for identifying health measurements and medical laboratory observations. It applies universal code names and identifiers to medical terminology related to electronic health records to assist in electronic exchange and gathering of clinical results. It was created in 1994 and is maintained by the Regenstrief Institute, a US non-profit medical research organization.
Long-Term Care (LTC)
This term refers to a range of services and supports in an institutional or community-based setting that help meet the medical and non-medical needs of people with a chronic illness or disability who cannot care for themselves for long periods. It is also called Long-Term Services and Supports (LTSS).
Master Patient Index (MPI)
A MPI is a patient database used by health care organizations to maintain accurate medical data across various departments. The database contains records for all patients served, with select demographics and unique identifiers for each patient
Meaningful Use (MU)
MU refers to the use of certified EHR technology to improve quality, safety, and efficiency; reduce health disparities; engage patients and family; improve care coordination as well as population and public health; and maintain privacy and security of patient health information. MU sets specific objectives that Eligible Hospitals and Eligible Professionals must achieve to qualify for federal Incentive Programs and to receive EHR Incentive payments. Since implementation of the Medicare and Medicaid EHR Incentive Programs, there have been three different stages of MU.
Merit Based Incentive Payments System (MIPS)
The MIPS is a Quality Payment Program authorized by the Medicare Access and CHIP Reauthorization Act of 2015. Participating Medicare Part B providers are eligible for a performance-based payment adjustment based on evidence-based and practice-specific quality data.
National Committee for Quality Assurance (NCQA)
NCQA is an independent non-profit organization in the US that works to improve health care quality through the administration of evidence-based standards, measures, programs, and accreditation.
National Provider Identifier (NPI)
The NPI is a unique 10-digit identifier issued to health care providers in the US and is required for Medicare and Medicaid as well as for many other payers. The NPI is used with electronic transactions identified in HIPAA.
Nationwide Health Information Network (eHealth Exchange or NHIN)
This term refers to a web-based set of standards, services, and policies that enable the secure exchange of health information over the Internet. It was developed through HHS but is managed by a non-profit industry coalition called Sequoia Project, and the acronym is now outdated. It is also known as the eHealth Exchange and may also be abbreviated as NHIN.
Patient Admission Alerts and Notifications
Patient Admission Alerts and Notifications allow providers to receive a notification/alert when their patient presents himself in a healthcare institution. No matter where that person seeks care, be it an emergency room or otherwise, their primary care doctor, or their care plan manager, can be notified.
Patient-Centered Medical Home (PCMH)
A PCMH is a model for transforming the organization and delivery of primary care. The Agency for Healthcare Research and Quality (AHRQ) defines a medical home not simply as a place, but as a model of the organization of primary care that delivers the core functions of primary healthcare.
Patient Portals allow for patient engagement, allowing patients to see their health information, interact with their care plans, and see and interact with their record. This encourages patients to be proactive in their own health, and enhance communication with providers.
Performing Provider System (PPS)
Providers cannot participate in DSRIP as standalone entities. Instead, providers are required to come together in coalitions called PPSs. Most PPSs are led by large safety net hospitals and/or public hospital systems and incorporate large networks of healthcare providers spanning the spectrum of services, including behavioral health providers. Currently, there are 25 PPSs. Some further consolidation may occur in the future, as the State’s overall goal is to have one PPS per region wherever possible.
Personal Health Record (PHR)
A PHR is an electronic application, or tool, used and controlled by an individual to maintain and manage health information in a private, secure, and confidential environment. It permits improved communication with and allows information to be shared with caregivers, family members, and providers.
Primary Care Payment Model (PCPM)
This term generically refers to a primary care delivery system that rewards value and quality by offering an innovative payment structure to support primary care practices to improve quality, access, and efficiency. As the term relates to either the EHR Incentive Programs, states are encouraged to consider aligning their clinical quality measurement (CQM) initiatives with such initiatives.
Primary Care Provider (PCP)
This term refers to a physician, nurse practitioner, clinical nurse specialist, or physician assistant, as allowed under state law, who provides, coordinates or helps a patient access a range of health care services.
Privacy and Security
Electronic health information exchange promises an array of potential benefits for individuals and the U.S. healthcare system through improved clinical care and reduced cost. At the same time, this environment also poses new challenges and opportunities for protecting individually identifiable health information. In healthcare, accurate and complete information about individuals is critical to providing high quality, coordinated care. If individuals and other participants in a network lack trust in the electronic exchange of information due to perceived or actual risks to individually identifiable health information, or the accuracy and completeness of such information, it may affect their willingness to disclose necessary health information and could have life-threatening consequences. Coordinated attention at the Federal and State levels is needed both to develop and implement appropriate privacy and security policies. Only by engaging all stakeholders, particularly consumers, can health information be protected and electronically exchanged in a manner that respects variations in individuals’ views on privacy and access.
Promoting Interoperability (PI) Programs
This is the new name of the former Medicare and Medicaid Electronic Health Record (EHR) Incentive programs and reflects CMS’ priority for interoperability and improved patient access to health information as well as a strong emphasis on measures that require exchange of health information between providers and patients.
Protected Health Information (PHI)
Under US law, this term refers to any information about the health status, provision of health care, or payment for health care that is created or collected by a covered entity, is transmitted by or maintained in electronic media or other form or medium, and can be linked to a specific individual. The term is defined at 45 CFR 160.103.
Provider-to-Provider Record Transfer
Provider-to-Provider Record Transfer is the ability to send secure email or messages between two providers, useful for transfer of a patient on discharge, or from primary care to specialty care. The Federal Program for this is called The Direct Project.
Public Health Agency (PHA)
This is a generic term for a government organization at the federal, state, or local level whose mission is to protect the health, safety, and security of the population represented.
Qualified Entity (QE)
A QE, formerly known as a RHIO (Regional Health Information Organization), is a local hub where a region’s electronic health information is stored and shared. There are QEs in New York State that each cover different areas from Buffalo to New York City. These QEs are the backbone of the SHIN-NY, providing the services that make secure, vital access to your health information possible statewide.
Quality Assurance (QA)
As it relates to health care, this term means maintaining a high quality of care by constantly measuring the effectiveness of the providers and organizations providing it.
Quality Payment Program (QPP)
This term refers to the Medicare Part B program, authorized by MACRA to provide physicians with tools and resources to improve health care quality and to potentially earn a performance- based payment adjustment. Alternative Payment Models (APMs) and the Merit-based Incentive Payment System (MIPS) are a part of the QPP.
Regional Health Information Organization (RHIO)
A RHIO is a non-governmental organization that exists as a New York State not-for-profit corporation to enable interoperable health information exchange via a common Statewide Health Information Network for New York (SHIN-NY) by participating in setting information policies through a statewide policy framework and governance process, implementing policies and ensuring adherence to such policies with a mission of governing its use in the public’s interest and for the public good, to improve healthcare quality and safety, and reduce costs. To fulfill this mission, RHIOs require commitment from multiple healthcare stakeholders in a geographic region, including physicians, hospitals, long term care and home care providers, patients, insurers, purchasers, and government. RHIOs are responsible for enabling interoperability through which individual stakeholders are linked together—both organizationally and technically through the SHIN-NY—in a coordinated manner for health information exchange and quality and population health reporting.
Rural Health Clinic/Center (RHC)
An RHC is a clinic located in a rural area designated by HRSA as a shortage area. It is not a Federally Qualified Health Center, rehabilitation agency or a facility primarily delivering behavioral health services, and it must employ non-physician practitioners such as physician assistants and nurse practitioners in rural areas. Defining legislation appears at 42 USC § 1395x(aa)(1).
The Statewide Health Information Network for New York (SHIN-NY) is a network of information transmitted between users. Regional Health Information Organizations collect health record data from the healthcare providers in their area and, with patient consent, allow this information to be shared securely with other providers in the region. The SHIN-NY connects these regional hubs to create a private and secure network spanning the entire State of New York.
Single Sign-On (SSO)
This term refers to a session and user authentication service that permits a user to use one set of login credentials (e.g., name and password) to access multiple applications. It authenticates the end user for all applications the user has been given rights to and eliminates further prompts when the user switches applications during the same session.
SMART on FHIR
An open, free, and standards-based universal API designed to turn EHRs into platforms for substitutable apps (like those available on smart phones). Innovators use it to write an app once and have it run anywhere in the healthcare system. Initially created with federal investment, SMAR is now an EHR federal certification requirement intended to enable access to patient-level data across a patient population.
Standards and Certification Criteria (S&CC)
This term refers to the required capabilities and related standards and implementation specifications that certified EHR technology must include to, at a minimum, support the achievement of Meaningful Use (MU) by Eligible Professionals and Eligible Hospitals under the Medicare and Medicaid EHR Incentive Programs. There have been multiple stages of S&CC, which complemented the stages of MU in the incentive programs.
Statewide Collaborative Process (SCP)
As health information technology grows, new policy must be written, and new standards set. An essential task of NYeC is to develop common policies, procedures, and technical approaches through an open and transparent process—the Statewide Collaborative Process—to support New York’s expanding health information infrastructure. These will ensure the highest quality of service, interoperability, and full patient privacy, security, and safety.
System Security Plan (SSP)
A SSP provides an overview of the security requirements of an information system and describes the controls in place or planned, responsibilities and expected behaviors of all individuals accessing the system and should be viewed as documentation of the structured process for planning adequate, cost-effective security protection for a major application or general support system.
Telehealth is the use of telecommunications technology to transmit health information from one location to another to improve health status. As such, telehealth enables connections among providers, and between providers and patients, linking potentially distant resources with more convenient sites of care. The patients may be situated in another medical facility or clinical office, may be at home, or, increasingly, may be mobile and simply interested in having certain clinical values monitored remotely.
Transition of Care (TOC)
This term refers to the movement of a patient from one setting of care, such as a hospital or nursing facility, to another setting, such as a patient’s home or another community setting. It is a measure in the Eligible Professional Meaningful Use Menu Set of Measures associated with the EHR Incentive Programs.
Two-Factor Authentication (2FA)
Authentication method that requires user to present at least two of the following three types of authentication factors to verify identity:
- Knowledge: something the usersknows
- Possession: something the userhas
- Inherence: something the useris
In health care, a user agreement is a legal document executed between a requestor and holder of data containing protected health information and/or personally identifiable information. Its purpose is to ensure that the requestor adheres to legal requirements associated with privacy and security of the information shared.
Value Based Payment (VBP)
In health care, this term refers to a payment approach that rewards providers for delivering high- quality and cost-efficient care, with programs intended to achieve better care for individuals, better health for populations, and lower the total cost of care provided. The acronym is also used to refer to Value Based Purchasing and Value Based Programs.
This glossary was adapted from one created by the Medicaid EHR Team (MeT) on behalf of and approved by the CMS Medicaid HITECH Team and one created by the New York eHealth Collaborative (NYeC).