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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Meaningful use

The government EHR incentive program, which began in 2011, requires eligible hospitals and eligible professionals to show "meaningful use" of their EHRs to qualify for the government funds. The meaningful use criteria get more difficult during the three phases of the program. In stage 2, the current phase, eligible providers must use their EHR for prescription and lab orders, record vital signs, maintain diagnosis and medication lists, provide a portion of their patients with online visit summaries, have at least 5 percent of patients view, download or transmit their electronic records (this rule has been scaled back), exchange clinical summaries with other providers in a percentage of "transitions of care" (such as hospital discharges and referrals to specialists), use clinical decision support tools, incorporate lab results into their EHRs, report on clinical quality measures, and provide reminders to patients for preventive and follow-up care. To date, CMS has spent more than $30 billion on EHR incentives. Providers have received the bulk of their incentives and now face financial penalties for not showing meaningful use.

Medicare fraud and abuse audits

CMS contractors do random audits of physicians, hospitals and other providers to find out whether they are defrauding Medicare, usually by sending by charging more than they should or by charging for services they didn't perform. (Medicare sets fee schedules every year, but providers can "upcode" to a higher level of service than they actually provided.) EHRs encourate fraud in two ways: First, they make it easier to generate documentation that justifies higher-cost codes. Second, some providers have fraudulently attested to meaningful use. CMS has directed its auditors to pay more attention to EHR documentation and has begun random audits of providers who have attested to Meaningful Use.

Merit-Based Incentive Program (MIPS)

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) replaces Medicare’s current method of paying physicians with two other approaches, both of which will take effect in 2019. One method gives physicians who participate in an “alternative payment model” such as an accountable care organization or a patient-centered medical home a 5 percent annual increase in their Medicare payments through 2024. Physicians who don’t participate in such an arrangement will be subject to MIPS, in which their Medicare payments will be adjusted upward or downward by 4 percent in 2019, increasing to 9 percent by 2022. Like the Value-Based Payment Program (see separate entry), MIPS uses quality and efficiency scores to determine whether physicians get a penalty or a bonus. About a third of the composite score is based on quality measures, which may reflect some factors outside physicians’ control, experts point out.

Mobile health

Mobile health, also called mHealth, encompasses mobile devices and applications used in healthcare. In this context, mobile devices include smartphones and tablets, as well as add-on devices. In some cases, smartphones can be converted into medical devices, such as an ECG or a stethoscope. Alternatively, they can be used in combination with add-on devices such as glucometers that transmit data via Bluetooth to a smartphone app. The overwhelming majority of mHealth apps are designed for wellness or fitness, such as diet and exercise apps. Consumers use most of these by themselves, but some apps allow users to share information with friends and family. Apps for monitoring chronic diseases have yet to gain much traction, mainly because most physicians are not yet willing to review the data. But some physicians are beginning to prescribe mHealth apps to their patients.

Mobile-native EHRs

Some vendors provide either full mobile-native EHRs or apps that supply limited EHR functionality. One vendor’s mobile app, for example, allows doctors to retrieve visit notes, view diagnosis and medication lists, write prescriptions, and send secure email. The small screen size of smartphones and the clumsiness of onscreen keyboards are barriers to mobile EHRs. But speech recognition ameliorates the keyboarding issue in some of these EHR versions. Although there are mobile-native EHRs for Android tablets and smartphones, physicians favor iOS devices.

Natural language processing

Under development for half a century, natural language processing, or the capability of computers to understand human language, is finally coming into its own in healthcare. The use of NLP with speech recognition engines in EHRs has not been very successful, because those applications grasp only a limited number of medical concepts and are not reliable enough for physicians to use in clinical care. But the use of cognitive computing systems (see: Big data) has produced NLP applications that can understand language in context. This enables healthcare providers to convert some of the unstructured data that comprises about 80 percent of EHRs into structured data that is available for analysis.

PACS/VNA

PACS may serve all hospital departments or may be split among radiology, cardiology and other departments. These systems house radiology images and reports and may include "radiology information systems" (RIS) that handle patient scheduling, image tracking, and results reporting. But in recent years, many hospitals have turned off their RIS and have integrated PACS with EHRs for RIS functions. Multiple PACS within a hospital or across hospitals and outpatient imaging centers are hard to integrate. Moreover, storage demands are growing exponentially. So a number of healthcare organizations now use vendor-neutral archives (VNAs) to store images from disparate PACS. Clinicians can access the VNAs directly from EHRs. Alternatively, some organizations use enterprise viewers to retrieve images from multiple PACS.

Patient cost accounting systems              

Cost accounting systems in hospitals record, analyze, and allocate costs to the individual services provided to patients, such as medications, procedures, tests, and room and board. These systems were once considered optional in healthcare. But in recent years, as value-based reimbursement has gathered momentum, most hospitals have started looking hard at their cost structure, from labor to supply chain costs. Physician costs are often measured in "relative value units," which assign work values to particular professional services based on an agreed-upon national formula. Hospitals usually analyze their costs and revenues within departments such as cardiology and surgery or service lines such as heart centers and maternity centers.

Patient portals

Largely because of the EHR incentive program, it's common for EHRs to have patient portals so that patients can view or download their records and message providers online. But those activities are still occurring only to a limited extent: For example, providers objected to the requirement in the government's EHR incentive program that just 5 percent of their patients view their records online. Although patient portals could greatly increase healthcare efficiency and improve the quality of care, the potential of this technology has yet to be fully exploited.

Patient scheduling systems

Patient scheduling, known as registration on the hospital side, goes beyond simple appointment booking. For new patients, this is the part of the process in which "patient demographics" – including name, contact information, age, sex, and insurance – are documented. In some organizations, schedulers verify insurance at this stage, before the patient arrives at the healthcare facility. There are separate ambulatory care and inpatient registration systems, and most hospitals also have surgical scheduling systems. Because no-shows can be costly to healthcare providers, scheduling systems may be connected to third-party reminder systems that send automated phone messages to patients prior to office visits or scheduled tests or procedures.

Pharmacy systems

Retail pharmacy systems bill insurance companies and pharmacy benefit managers for prescription drugs and check prescriptions for safety before pharmacists fill them. Most pharmacies use third-party drug databases that help them identify potentially adverse drug-to-drug and drug-to-allergy interactions. Retail pharmacy systems are connected online with physician offices through a company calls Surescripts, which is owned by the trade associations of the chain and independent pharmacies. Using Surescripts, physicians automatically transmit their electronic prescriptions into the pharmacy systems, eliminating errors due to poor handwriting and faulty data entry.

Physician performance measurement

In most physician groups, performance was traditionally measured in terms of productivity – either revenue- or RVU-based – that was reflected in each doctor's compensation. But, as healthcare moves from pay for volume to pay for value, healthcare organizations are factoring quality and efficiency into physician pay. So they need financial systems that can not only track RVUs, but can also measure each provider's utilization of resources, including supplies, tests, and staff time. Utilization management is especially important in organizations that are taking financial risk. Today, most programs that measure performance in this way are part of population health management solutions.

Physician Quality Reporting System (PQRS)

The Physician Quality Reporting System is the source of the data that the Centers for Medicare and Medicaid Services (CMS) uses to determine whether physicians should have their Medicare payments adjusted up or down as CMS phases in value-based payments for doctors (see separate entry). Most physicians who report their quality data to PQRS still use a claims-based method, but they’ll have to report electronically from their EHRs, starting in 2018. Today, many physicians who report electronically can do so either through a special clinical data registry (often operated by a specialty society) or can send the data directly to CMS. The latter approach requires dedicated software from an EHR vendor or an outside data submission vendor—both of which cost money. Practices of 25 or more physicians can use a Group Practice Reporting Option (GPRO) web interface to report. CMS recently aligned its meaningful use and PQRS measures so that practices only have to report their quality data once.

Picture archiving and communications system (PACS)

A PACS houses radiology images and reports in hospitals and standalone imaging centers. They may serve all hospital departments or may be split among radiology, cardiology and other departments. PACS often include "radiology information systems" (RIS) that handle patient scheduling, image tracking, and results reporting. But in recent years, many hospitals have turned off their RIS and have integrated PACS with EHRs for RIS functions. The images themselves are usually in a format called DICOM that is distinct from the databases used in EHRs. Also, different PACS are not interoperable. So some organizations use enterprise viewers embedded in their EHRs to view images in multiple PACS.

Population health management (PHM)

Population health management seeks to optimize the health of all patients and to prevent their chronic conditions from worsening. This approach involves the use of care teams, care coordination across care settings, continuous care, patient engagement techniques, care management of the sickest patients, and centralized resource planning. PHM requires the collection, aggregation and analysis of patient data from a variety of sources, some of it in near real time. The antithesis of the episodic "sick care" approach, PHM is essential to organizations that take financial risk for care.

Practice management (PM) systems

Most physician practices have PM systems that they use for scheduling, billing and financial accounting. Originally standalone, these systems were later integrated with EHRs and exchanged billing and patient demographic data across those interfaces. That is still true of less expensive EHRs and PM systems, but the leading vendors now integrate the clinical and practice management sides in a single application. That approach allows billing people, for example, to review clinical notes for coding purposes. Hospital financial systems are separate from the PM systems of hospital-owned practices, but the hospital's central business office often handles billing and scheduling for those practices.

Predictive modeling

Predictive modeling is a type of analytics used to forecast the future health status of individuals and to classify patients by their current health risk (risk stratification). It can also be used to risk-adjust the aggregate health risks of a particular group of patients, such as a physician's patient panel. This is important to healthcare organizations that are negotiating risk contracts, because they want to get paid more for caring for sicker patients. Predictive modeling is used to identify high-risk patients who need care management, to forecast which patients are most likely to incur high costs in the coming year, and to predict which patients are likely to be readmitted to the hospital. Most predictive modeling algorithms are based on claims data, which is the broadest dataset. However, clinical data is more timely and actionable and includes many elements missing from claims data.

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