Chapter 21: Glossary of Healthcare IT Terms
Chapter 21: Glossary of Healthcare IT Terms
Key Definitions
This glossary provides pragmatic definitions of healthcare IT terms used throughout this book.
ACO (Accountable Care Organization): Groups of providers/hospitals that share risk and reward for improving quality and reducing costs for a defined patient population. Payment tied to quality metrics and cost savings.
ADT (Admission/Discharge/Transfer): HL7 v2 message type family for patient movement events (A01=admit, A03=discharge, A08=update).
BA/BAA (Business Associate/Business Associate Agreement): Entity that handles PHI on behalf of covered entity, and the required HIPAA contract governing that relationship.
C-CDA (Consolidated Clinical Document Architecture): XML-based document standard for clinical summaries, discharge summaries, continuity of care documents. Being replaced by FHIR.
CDI (Clinical Documentation Integrity): Process and tools to improve documentation quality, specificity, and completeness to support accurate coding and reimbursement.
CDS (Clinical Decision Support): Systems that provide clinicians with knowledge and patient-specific information to enhance care decisions (alerts, reminders, order sets).
CDS Hooks: FHIR-based standard for integrating CDS into EHR workflows (e.g., trigger alert when ordering medication).
CPT (Current Procedural Terminology): AMA-maintained code set for procedures and services, used for billing (e.g., 99213 = office visit). Updated annually (January).
DICOM (Digital Imaging and Communications in Medicine): Standard for medical imaging storage, transmission, and workflow (radiology, cardiology).
DRG (Diagnosis Related Group): CMS classification system for inpatient reimbursement. Groups diagnoses/procedures with similar resource use into payment categories.
EDI X12: ANSI electronic data interchange standard for administrative transactions (270/271=eligibility, 837=claims, 835=remittance).
EHR/EMR (Electronic Health Record/Electronic Medical Record): Digital patient records. EHR = longitudinal, cross-organization; EMR = single-organization.
ELR/eCR (Electronic Lab Reporting/Electronic Case Reporting): Automated reporting of lab results and notifiable diseases to public health agencies.
FHIR (Fast Healthcare Interoperability Resources): HL7 RESTful API standard for healthcare data exchange. Resources (Patient, Observation, etc.) + APIs.
HCC/RAF (Hierarchical Condition Category/Risk Adjustment Factor): Risk adjustment system for Medicare Advantage. HCC codes drive RAF score (payment multiplier).
HEDIS (Healthcare Effectiveness Data and Information Set): NCQA quality measures for health plans (diabetic eye exams, breast cancer screening, etc.).
HIE (Health Information Exchange): Entity or platform that facilitates sharing of patient data across organizations (e.g., state/regional HIE).
HITECH (Health Information Technology for Economic and Clinical Health Act): 2009 law strengthening HIPAA, promoting EHR adoption via meaningful use incentives.
HL7 v2: Messaging standard for clinical/administrative data exchange. Common in hospitals (ADT, ORU, ORM messages). Pipe-delimited format.
ICD-10-CM/PCS (International Classification of Diseases, 10th Revision): WHO diagnosis codes (CM=Clinical Modification for outpatient) and CMS procedure codes (PCS=Procedure Coding System for inpatient). Updated annually (October).
LOINC (Logical Observation Identifiers Names and Codes): Standard for lab tests and clinical observations (e.g., 2339-0 = glucose, serum).
MDM/EMPI (Master Data Management/Enterprise Master Patient Index): Systems for patient/provider identity resolution and data governance. EMPI matches patients across systems without universal ID.
NCPDP (National Council for Prescription Drug Programs): Pharmacy data exchange standard (SCRIPT for ePrescribing, Telecommunication for claims).
ONC/USCDI (Office of the National Coordinator/U.S. Core Data for Interoperability): ONC is federal health IT regulator. USCDI defines minimum data elements for interoperability (updated annually).
PACS (Picture Archiving and Communication System): Medical imaging storage and viewing system (radiology, cardiology). Integrates with EHR via HL7/DICOM.
PHI/PII (Protected Health Information/Personally Identifiable Information): PHI = health data + identifiers (HIPAA). PII = personally identifiable data (broader).
RCM (Revenue Cycle Management): Processes for patient registration, eligibility, coding, claims, payment posting, denials, A/R follow-up.
SNF (Skilled Nursing Facility): Post-acute care facility for patients needing skilled nursing/rehab. Medicare pays via RUGs (Resource Utilization Groups).
SNOMED CT (Systematized Nomenclature of Medicine Clinical Terms): Comprehensive clinical terminology (400K+ concepts). Used for problem lists, assessments, procedures.
TEFCA (Trusted Exchange Framework and Common Agreement): ONC framework for nationwide interoperability via QHINs (Qualified Health Information Networks).
Usage Note: These definitions are simplified for practical use. Refer to official standards (HL7, WHO, CMS) for complete specifications.
Next Chapter: Chapter 22: Key U.S. Healthcare Regulations and Acts