Health IT glossary

CIO.com's health IT glossary provides definitions and information for many terms used in the complex field of healthcare-related information technology and management systems.

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Capitation

Capitation is a payment method under which physicians, physician practices, or other healthcare organizations receive a flat rate for all services they provide to a particular person during a period of time. In health plan contracts, the amount is usually stated in dollars per member per month (PMPM). The provider gets the monthly capitation payment regardless of whether the patient seeks or receives care. This population-based approach places the provider at financial risk. If the value of the care delivered to members of a patient panel exceeds the total capitation amount for that panel, the provider loses money; if it falls below the budget, the provider keeps the difference. In a variant known as "global capitation," a provider is financially responsible for all care that the patient receives, including hospitalization and the cost of drugs.

Claims clearinghouses

Electronic claims clearinghouses are a vital link in the chain that connects healthcare providers to payers. While some providers directly bill their larger payers, such as Medicare and Blue Cross/Blue Shield plans, most claims go through claims clearinghouses to the multitude of health plans and government agencies that provide health insurance. Clearinghouses edit the claims so that they can be processed by the many different systems of private insurers and government intermediaries. In some cases, clearinghouses bounce claims back to providers if they're missing information or were submitted in the wrong format. In addition, the clearinghouses submit and return responses to provider inquiries such as eligibility and claims status requests. They also route electronic remittance advance that providers need for payment posting and claims denial management.

Clinical decision support (CDS)

Clinical decision support consists of reminders and alerts that prompt health IT users either to do something they might otherwise forget or to avoid an action that might harm a patient. In the second category are drug interaction checkers included in the electronic prescribing modules of EHRs and standalone e-prescribing applications. These systems warn physicians when a drug they’re prescribing might have an adverse interaction with another medication the patient is taking or with a known allergy of the patient. Many EHRs also have health maintenance alerts that remind physicians to provide preventive or chronic care services that are recommended for patients with particular characteristics. These are not as robust as standalone electronic registries, which contain more specific and timely information about patients. Meaningful use requires use of CDS.

Clinical documentation improvement (CDI)

CDI is an approach, often supported by specialized software, designed to help physicians improve their documentation of patient encounters and procedures. Implemented chiefly by hospitals, CDI programs aim to present a more accurate description of the care that has been delivered to patients. Better documentation can contribute to better continuity of care, because it helps subsequent caregivers understand a patient’s status and what has been done for him or her. In addition, it can boost a hospital’s bottom line by ensuring that the severity of a patient’s condition is properly documented to support the maximum allowable charges. And under the ICD-10 diagnostic coding system, which is much more complex than the previous coding system (see separate entry), complete documentation is essential to support insurance claims.

Cloud-based EHRs

In recent years, the quantum leap in the speed and bandwidth of Internet connections has made it practical to base EHRs in the cloud. Many physician practices, especially smaller ones, have taken advantage of this option. These groups would rather pay a monthly fee that covers maintenance than make a large upfront investment in servers and software – even though the five-year cost of ownership is roughly similar in either case. Hospitals, in contrast, have been slow to move to the cloud. In 2011, just 55 percent of them had any data or applications in the cloud. By 2014, 83 percent of hospitals did, but only half of them had any cloud-based clinical applications.

Cognitive computing

A branch of artificial intelligence, cognitive computing uses machine learning and massively parallel computer processing to build on big data techniques. As typified by IBM Watson, the supercomputer that won the "Jeopardy" game in 2011, a cognitive computing system is a collection of overlapping, reasoning algorithms that can be expanded and updated as the system learns from experience. The applications of cognitive computing in healthcare include advanced natural language processing, the ability to convert unstructured data into structured data, the ability to search the medical literature quickly for clinical decision support, and the ability to correlate large numbers of unrelated data sources, including genomics and non-medical determinants of health, to find clinically useful connections.

Computer assisted coding (CAC)

Another new type of application uses natural language processing to help hospital coders pick the correct codes for a given office visit, test or procedure. CAC does this by extracting code-related terms from electronic text to supplement the coded elements in the EHR's structured fields. It has been shown to improve productivity by automating parts of the coding process. In outpatient departments such as radiology and pathology, CAC can automate most of the coding, but more human intervention is required in inpatient coding. CAC is expected to help health care organizations cope with the new requirements of ICD-10 coding (see the regulatory section).

Computerized practitioner order entry (CPOE)

CPOE is the process of entering electronic orders for medications and tests with the help of computerized clinical decision support. Used in acute-care hospitals and emergency departments, CPOE has proved to be challenging for staff physicians, some of whom are not computer-literate and have had no experience entering orders into a computer. As a result, doctors sometimes delegate these tasks to nurses. By doing so, they lose the benefit of the evidence-based decision support, which can help them avoid adverse drug interactions and redundant testing. CPOE can be difficult to use, however, and, in some cases, has been blamed for endangering patient safety.

Data lake

In place of traditional data warehouses, some healthcare organizations use a big data approach known as a “data lake.” Instead of relying on a relational database, a data lake often employs the Hadoop software framework for distributed storage and distributed processing of large datasets in cloud-based computer clusters. Massively parallel computing and a late-binding rules approach allow a wide variety of data to be aggregated quickly. The data interface does not have to be rewritten to accommodate new kinds of queries or use cases. Reports can be rapidly assembled by using configuration files that identify business rules at run-time. This ad hoc approach enables reports to be delivered in as little as a day — a feature that can be valuable in both patient and population health management.

Data warehouses

Healthcare systems and accountable care organizations (ACOs) use data warehouses to aggregate, normalize and analyze data from multiple systems. Before healthcare organizations began using business and clinical intelligence tools, few of them had data warehouses. Far more of them do today, but most of these organizations are still doing retrospective analyses that allow some latency in the database. As predictive modeling to forecast the health risks of individuals and populations takes center stage, some organizations are adopting a "late-binding" data warehouse architecture. This approach allows them to assemble data quickly for particular purposes by binding data to business rules on an as-needed basis rather than programming it all beforehand.

Direct messaging

The Direct Project, a secure clinical messaging protocol based on standard Internet protocols, was devised in 2011 by a private/public consortium. Direct messaging allows providers to push messages with document attachments to other providers. Health information service providers (HISPs), most of them owned or contracted by EHR vendors, handle the transmission of these messages and make sure they get to the right providers at their Direct addresses. Under the 2014 EHR certification rules, vendors are required to include Direct capability in their products so that providers can exchange care summaries. Despite all of these efforts, only a small minority of providers used Direct messaging in the first half of 2015. But a recent survey shows that two-thirds of HIEs are using the protocol for enabling data exchange among their participants.

EHR certification

To qualify for meaningful use incentives, eligible providers must use certified EHRs that have been tested by government-approved certification bodies. The certification criteria have been devised so that users of these EHRs have all of the capabilities needed to show meaningful use. So, like the EHR incentive program, the certification program has grown more complicated and demanding over time. Because many EHR vendors had difficulty in rewriting their applications, CMS allowed providers to use EHRs certified under 2011 rules in 2014, but all of them had to use 2014-edition EHRs in 2015 to qualify for meaningful use. By 2018, everyone will have to use EHRs that have been certified to new standards that will enable them to meet the meaningful use stage 3 requirements.

EHR security

Government regulations promise onerous fines and public scrutiny to healthcare organizations that allow data security breaches. So hospital systems, in particular, are security-conscious and have gone to great lengths to protect the security of protected health information (PHI). For example, many healthcare organizations don't allow clinicians to store PHI on end-user devices. They keep everything on the server and, in some cases, adopt a virtual desktop approach to facilitate the use of EHRs and other applications. Nevertheless, security breaches are increasing at a frightening rate, partly because of the theft or loss of unencrypted laptops and other mobile devices. Meanwhile, many physician practices have yet to perform government-mandated security risk assessments.

eICU and telestroke

Both of these terms refer to the use of remote monitoring technology to provide appropriate staffing to understaffed areas of community hospitals. In an eICU setup, a critical care specialist in an academic medical center or a remote monitoring center can track patients in another hospital’s intensive care unit, using both monitoring data and remote cameras. Some organizations have used this strategy to reduce costs and improve patient outcomes. Telestroke systems allow neurologists to diagnose strokes remotely in time to order life-saving “clot buster” medications. The neurologists review and interpret CT brain scans that have been stored and forwarded, and they examine the patient via videoconferencing. In some systems, robots with cameras wheel up to the patient’s bed, allowing the examining physician to make more accurate observations.

Electronic health records (EHRs)

Also known as electronic medical records (EMRs), EHRs have been commercial products since the mid-1990s, but didn't begin to catch on among physicians until about 10 years ago. Besides replacing paper charts with electronic documentation, ambulatory care EHRs include diagnosis, allergy and drug lists, modules for ordering tests and medications, care plans and clinical decision support features. Hospitals also have EHRs for their inpatient and outpatient departments, including emergency departments. Larger healthcare organizations connect their hospital systems with the ambulatory care EHRs used in physician offices. In some cases, they do this through interfaces; in other cases, everyone uses products from the same EHR vendor. Different kinds of EHRs are found in nursing homes, rehab facilities and home health agencies.

Electronic payment posting and funds transfer

Electronic payment posting is a feature of most practice management/hospital financial systems. When electronic remittance advice (ERA) comes into the system from a health plan, it can automatically post a payment to the account. This is a great time saver and is much more accurate than manual posting. Denial management staff can also use the ERA to pinpoint problems in denied claims so they can correct and resubmit them. Many insurers also transfer payments automatically to providers' bank accounts, speeding up their cash flow. For this system to work properly, payment posting and ETF must be in synch with each other.

Electronic prescribing

Once confined to standalone e-prescribers, electronic prescribing is now a core function of most EHRs. According to Surescripts, which processed 1.2 billion e-prescriptions in 2014, 56 percent of physicians prescribed electronically that year. E-prescribers include drug interaction checkers and other types of clinical decision support. They record the prescriptions automatically in the EHR, and the EHR's scheduling system populates the demographic fields (name, date of birth, insurance plan, etc.) in each e-prescription. Until recently, most states prohibited electronic prescribing of controlled substances; that has now changed, but few e-prescribers allow doctors to prescribe controlled substances.

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