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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Quality measurement and reporting

Government regulations require health care providers to report on quality measures, using either administrative or EHR data. Many private payers use claims data to evaluate the quality and cost of providers. To show meaningful use, providers must extract data from their EHRs. They may report it directly to CMS or use special registries for reporting. Because of the deficiencies of structured data in EHRs, many organizations must assign clinical staff to comb through patient records to locate the desired data. EHR vendors also have difficulty in programming their systems to meet CMS quality reporting requirements.

Referral tracking

Patients don't always see the specialists to whom their primary care doctors refer them, and specialists don't always send reports on the patients they do see to the referring physicians. To close this information gap, some organizations use EHR modules or third party software that alert physicians when they have not received a report back from a specialist. Some hospitals use automated messaging applications that surveys recently discharged patients to find out, among other things, whether they have made an appointment to see a primary care physician. If not, a nurse will call the patient and refer them to a doctor in the organization if they don't have one.

Registries

Patient registries show the services that have been provided to each patient, when that service was performed, and when people with particular conditions are due for follow-up visits or tests. They also include demographic information, lab results, and medications. Registries have analytics that can be applied to populations and subgroups, such as patients with diabetes or hypertension who have out-of-range lab values. While some EHRs include registries, they're usually rudimentary and lack basic analytic tools. Robust registries, which may be standalone or incorporated into data warehouses are considered more useful in PHM.

Remote patient monitoring

Remote monitoring can be done via mobile apps or with home monitoring equipment. Nevertheless, most pilots of this technology have focused on home monitoring. Remote monitoring has been shown to have health benefits for patients with congestive heart failure (CHF), and many hospitals are interested in using it to prevent CHF patients from being readmitted. Some healthcare systems and health plans are also investigating the use of home monitoring in treating chronic diseases such as hypertension and diabetes as part of population health management. As noted earlier, most physicians are still not ready to accept data from mobile chronic disease apps. Few of these apps have been tested or approved by the FDA. Moreover, clinicians need better screening mechanisms to filter relevant data from the mobile data streams.

Revenue cycle management

Physician practices and hospitals do revenue cycle management (RCM) to maximize their revenue and minimize bad debt. The key elements of RCM are insurance eligibility verification, copayment collection, coding of diagnoses and procedures for billing, claims submission and tracking, payment posting, accounts receivable management, and reporting and benchmarking. Practice management and hospital patient accounting systems are often coupled with third-party solutions for certain RCM functions. Some healthcare organizations outsource RCM, which can expand their resources but is costly and requires them to give up some control. To reduce the amount of bad debt because of the inability to collect from patients who are uninsured or have high deductibles, some hospitals have installed software to locate alternative sources of payment, develop payment plans, and find financial assistance for those unable to pay.

Risk adjustment

Risk adjustment is a methodology used to compare the aggregate health risks of a physician's or a healthcare organization's patients or a health plan’s members to those of another doctor, healthcare entity, or insurance plan. The calculation of health risk is usually derived from claims data, which includes information on healthcare services, medications, age and gender. Risk adjustment may be used to make payments fairer or to help healthcare organizations benchmark their performance internally or against those of other organizations. Health plans also use risk adjustment models, such as the ACG Predictive Model from Johns Hopkins University, in provider profiling.

Risk management tools

While a relatively small number of healthcare organizations are now taking financial risk for care delivery, this method of payment is expected to spread in coming years as large healthcare systems and medical groups seek to maximize their return on investment in PHM infrastructure. Today, most risk-bearing provider entities outside of California are accountable care organizations (ACOs). ACOs use data warehouses and registries to aggregate and analyze data. They measure their own performance on quality and efficiency, and they use budgeting and forecasting tools to manage financial risk. When they partner with health plans, ACOs may also analyze claims data to track the movement of patients to non-network providers.

Risk stratification

The classification of patients by health risk is a cornerstone of population health management. At the population level, risk stratification allows health leaders to monitor and track the health status of various subpopulations and to review the organization's performance in caring for those groups. At the level of individual patients, risk stratification enables the organization to identify the patients who are likely to incur the highest health costs in any given year. Patients can be classified as low-, medium- and high-risk so that care teams can intervene to prevent people who have moderate chronic diseases from becoming acutely ill. This approach can reduce the number of costly ER visits and hospitalizations.

Secure messaging

Patient portals can be used for secure messaging between physicians and patients. This technology, which goes back 15 years, usually requires patients to visit the portal to view their messages; in some cases, they may receive emails saying that a message from their provider is waiting for them. Patients can also use portals to ask questions about their health conditions, their care plans, or how to take their medications. Some physicians have discovered that patients don’t always check their messages on the portal, so they send them text messages.

Single sign on

The idea of logging on once to gain access to multiple systems is not unique to healthcare, but it has some specific implications in this industry. Because physicians and nurses are so busy and depend so much on their EHRs, there is a basic tension between health IT security and the ability of providers to do their jobs. Single sign-on speeds up their access to clinical systems, but it also creates some security vulnerabilities, such as weak or stolen credentials. Perhaps as a result, fewer than half of U.S. acute-care hospitals use single sign on systems. Some of the healthcare systems that do use it confine SSO access to enterprise workstations, requiring remote users to log on separately to each system.

Stark law

The federal Stark law governs physician self-referral for Medicare and Medicaid patients. Self-referral occurs when a doctor refers a patient to a facility in which he or she has a financial interest, such as a lab, an ambulatory surgery center, or a hospital. Congress passed the original self-referral statute, sponsored by then Rep. Pete Stark (D-Calif.), in 1989. A second version of the Stark legislation, which contained more exceptions than the first, was adopted in 1992 and amended several times after that. The latest version, which passed in 2007, includes an exception that allows hospitals to subsidize physician purchases of EHR software up to 85 percent of the purchase price, as well as training costs. A related “safe harbor” also exists in the Anti-Kickback Act (AKA), which prohibits hospitals from providing anything of financial value to physicians in return for patient referrals. Originally scheduled to sunset at the end of 2013, the Stark exception and the AKA safe harbor have been extended through 2021.

Telehealth

Telehealth, sometimes called telemedicine, encompasses virtual visits, remote patient monitoring, and educational and support applications. There is a lot of overlap between telehealth and mHealth; however, telehealth includes home monitoring of health conditions, as well as online consultations and support materials that can be accessed on desktops and laptops with Internet connections. None of this has yet joined the mainstream of healthcare. But it is believed that the shift to value-based reimbursement will change that by paying doctors for non-visit care. Some experts predict that telehealth will change how healthcare is delivered. Not only will it reduce the number of unnecessary office visits, they say, but it will also allow doctors to monitor their patients’ health continuously.

Telehealth regulations

In recent years, audio and/or video "virtual visits" between consumers and physicians have spread across the country (see the mobile and telehealth section). The majority of states now require private health plans to cover these visits in the same way that they would pay for office visits. Some states also provide some telehealth coverage through their Medicaid programs. To date, Medicare has declined to cover most telehealth services except in rural areas. The agency typically requires the patient to be in an office with a primary care physician who is consulting a specialist remotely. In contrast, private insurers cover services provided remotely to patients wherever they are, on computers or smartphones.

Value-based Payment Program

The Centers for Medicare and Medicaid Services (CMS) has embarked on a pay-for-performance program that financially rewards or penalizes hospitals, physicians and certain other professionals who participate in Medicare, based on their quality and efficiency scores. The hospital portion of this Value-based Payment Program began in October 2012. CMS started to apply a “value-based modifier” to the reimbursement of physicians in groups of 100 doctors or more in 2015, based on 2013 performance. In 2016, the modifier will be applied to groups of 10 or more doctors; in 2017, all physicians will be affected. The quality scores in this program are based on Physician Quality Reporting System (PQRS) data. Physicians who don’t participate in PQRS will lose 2 percent of their Medicare reimbursement in 2016. Starting in 2019, the value-based payment, PQRS and meaningful use programs will all be folded into the Merit-Based Incentive Program (MIPS) under a new law that changes how Medicare pays physicians.

Vendor-neutral archive (VNA)

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 their EHRs. Data migration from PACS systems to VNAs can be tricky and can take anywhere from several months to a few years. In the interim, healthcare providers need continuous access to the stored images and reports. To make matters worse, some PACS store data in proprietary formats that make it hard to extract. Many healthcare organizations view VNAs as a vehicle to liberate their images from vendors that seek to lock them in.

Virtual visits

Remote consultations, as noted earlier, have been growing rapidly and no longer just involve patients and physicians in rural areas. In recent years, many health plans and employers have contracted with telehealth services that provide 24/7 access to physicians via phone or video chat on smartphones and desktop/laptop computers. These can be combined with photos of relevant portions of the body. While the medical establishment opposes allowing doctors to diagnose and prescribe remotely to people they’ve never met, some healthcare organizations have quietly begun offering virtual visits to their own doctors’ patients.

Wearable sensors

One of the fastest growing areas of mHealth, wearable sensors track everything from activity to vital signs such as heart rate, metabolic rate, and heart rhythms. These sensors may be imbedded in wrist bands, chest patches, or other kinds of devices. Consumers use these wearables and their associated apps mostly to track their own health, but they could also be used for continuous monitoring of people with chronic conditions. As with add-on devices like glucometers and digital blood pressure cuffs, some wearables use Bluetooth to connect with smartphones. The consumer can then view the data and/or upload it to a data center in a healthcare organization.

Copyright © 2016 IDG Communications, Inc.

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