Accountable Care

A model of healthcare delivery that emphasizes collaboration and coordination among healthcare providers, with a focus on improving outcomes and reducing costs.

Accountable Care Community (ACC)

A collaborative approach that extends beyond traditional healthcare providers to involve community organizations, social services, and public health agencies in addressing population health needs, improving coordination, and health outcomes.

Accountable Care Network (ACN)

An integrated network of healthcare providers, including hospitals, physicians, and other care providers, working collaboratively to improve quality of care, enhance patient outcomes, and reduce costs within a defined population.

Accountable Care Organization (ACO)

A group of healthcare providers, including doctors and hospitals, who work together to coordinate care for patients and reduce costs.

Accountable Care Unit (ACU)

A dedicated healthcare team consisting of physicians, nurses, and other providers, working collaboratively to manage the care of a specific group of patients, focusing on care coordination, communication, and quality improvement.

Accreditation

Accreditation is sefl-assesment and external peer review process used by healthcare providers to accurately assess the level of performance ain relation with the standards that has been implemented

Activity-based cost accounting

A cost accounting method that assigns costs to specific activities or services based on their actual consumption of resources, providing a more accurate understanding of costs associated with delivering healthcare services.

Activity-based costing (ABC)

Activity-based costing is a cost accounting method that identifies and assigns costs to specific activities within an organization. It helps in understanding the true cost drivers of products and services by allocating overhead expenses based on the activities that generate them. This approach provides more accurate and detailed insights into the costs associated with different activities, allowing for better cost management and decision-making.

Actuarial value

Actuarial value is a measure used in health insurance to assess the level of coverage provided by a plan. It represents the percentage of healthcare expenses that a health insurance plan is expected to cover for a standard population. Actuarial value helps individuals compare and understand the cost-sharing features of different health insurance plans, enabling them to make informed decisions based on their healthcare needs and financial circumstances.

Acuity

Acuity refers to the severity or complexity of a patient's medical condition. It is often used in healthcare settings to determine the level of care required and the allocation of resources. Acuity levels help healthcare providers prioritize patients, assign appropriate staff, and ensure that patients receive the right level of medical attention and resources based on the severity of their condition.

Adjusted Gross Income (AGI)

Adjusted Gross Income is a term used in taxation to calculate an individual's taxable income. It is derived by subtracting specific deductions, such as business expenses, student loan interest, or alimony payments, from the total income earned. AGI is an important figure in determining an individual's tax liability and eligibility for certain tax credits and deductions.

Administrative Rights

Administrative rights, also known as administrative privileges or admin rights, refer to the level of access and control granted to a user or account within a computer system or network. Users with administrative rights have the authority to modify system settings, install or uninstall software, and perform other critical tasks that regular users do not have permission to do. Administrative rights are usually restricted to trusted personnel to ensure the security and stability of the system.

Admission, discharge, and transfer (ADT) system

An ADT system is a software or information management system used in healthcare facilities to track and manage the movement of patients. It records admissions, discharges, and transfers of patients, along with relevant demographic and clinical information. ADT systems help healthcare providers efficiently manage patient flow, streamline communication between departments, and maintain accurate records for billing and administrative purposes.

Advance premium tax credit (APTC)

The advance premium tax credit is a subsidy provided under the Affordable Care Act (ACA) in the United States to help eligible individuals and families afford health insurance premiums. The APTC is based on the individual's estimated annual income and is applied in advance to reduce the monthly insurance premium payments. The credit helps make health insurance coverage more affordable for those who qualify.

Adverse Event Reporting

Adverse Event Reporting involves systematically collecting and analyzing data about unexpected or harmful events that occur during medical treatments or the use of pharmaceutical products. This process helps regulatory agencies, healthcare professionals, and researchers identify potential safety concerns, assess risks, and enhance patient safety by improving healthcare practices and interventions.

Affordability exemption

An affordability exemption refers to a provision in healthcare regulations that exempts individuals from the requirement to have health insurance if the available plans in their area are considered unaffordable based on their income. The exemption is granted when the cost of obtaining the lowest-priced health insurance plan exceeds a certain percentage of the individual's income.

Affordable Care Act (ACA)

Also known as Obamacare, it is a federal law enacted in 2010 that aims to increase the accessibility and affordability of healthcare insurance in the United States.

Affordable coverage

Affordable coverage refers to health insurance plans that are reasonably priced and within financial reach for individuals and families. The affordability of coverage is typically assessed based on the premiums, deductibles, and out-of-pocket costs associated with the insurance plan compared to the individual or family's income.

Agent and broker (health insurance)

In the context of health insurance, an agent or broker is a licensed professional who assists individuals and businesses in finding and purchasing suitable health insurance plans. They act as intermediaries between insurance companies and consumers, providing guidance, information, and personalized recommendations to help individuals make informed decisions about their health insurance options.

Alert Fatigue

Alert fatigue is a phenomenon that occurs when individuals, particularly healthcare professionals, become desensitized or overwhelmed by a high volume of alerts or notifications generated by electronic systems or devices. It can lead to a decreased response to critical alerts, missed or delayed actions, and an overall reduction in attentiveness to important information. Managing alert fatigue is crucial to ensure that important alerts are not overlooked and that healthcare providers can effectively prioritize and respond to critical situations.

Allowed amount

The allowed amount, also known as the allowable charge or allowable fee, is the maximum reimbursement or payment that a health insurance plan will cover for a specific healthcare service or procedure. It is typically determined by the insurer based on negotiated rates with healthcare providers or predetermined fee schedules. The allowed amount may differ from the actual billed amount, and any difference may be the responsibility of the patient as a co-payment, co-insurance, or deductible.

Ambient Assisted Living

Ambient Assisted Living refers to a technology-driven approach that creates smart and supportive environments for elderly individuals and those with disabilities. By incorporating sensors, smart devices, and remote monitoring systems into living spaces, this concept aims to improve the quality of life and independence of these individuals by offering assistance with daily tasks, safety monitoring, and timely alerts for caregivers or healthcare providers.

Ambulatory care

Ambulatory care refers to healthcare services and medical treatments provided on an outpatient basis, where patients do not require overnight hospitalization. Ambulatory care settings include clinics, physician's offices, urgent care centers, and other facilities where individuals receive medical attention for a wide range of conditions, examinations, procedures, and treatments, often returning home the same day.

Ambulatory care EHRs

Electronic Health Record (EHR) systems specifically designed for use in ambulatory care settings, such as clinics or outpatient facilities, to manage patient health records, appointments, and clinical workflows.

Ambulatory EHR systems

Electronic Health Record (EHR) systems used in ambulatory care settings to digitize and streamline various aspects of patient care, including documentation, order entry, and communication between healthcare providers.

Ambulatory Medical Record (AMR)

A comprehensive electronic record that contains medical and clinical information about patients who receive care in ambulatory or outpatient settings, providing a consolidated view of their health history and treatments.

Ambulatory System

A healthcare system or software specifically designed for ambulatory care settings, supporting the management of patient appointments, clinical documentation, billing, and other operational aspects of outpatient care.

Antimicrobial Stewardship

Antimicrobial Stewardship involves a set of coordinated strategies and actions aimed at promoting the responsible use of antibiotics and other antimicrobial agents. This approach helps mitigate the development of antimicrobial resistance, which is a major global health concern. Antimicrobial Stewardship programs ensure that antibiotics are prescribed and used appropriately, optimizing their effectiveness, minimizing side effects, and preventing the emergence of drug-resistant infections.

Apple HealthKit

Apple HealthKit is a software framework developed by Apple that allows users to collect, store, and share their health and fitness data on compatible Apple devices, such as iPhones and Apple Watches. HealthKit integrates data from various health and fitness apps and devices, providing users with a centralized platform to monitor and manage their health information.

Apple ResearchKit

Apple ResearchKit is an open-source software framework developed by Apple that enables researchers and healthcare professionals to create mobile applications for collecting and analyzing data for medical research studies. ResearchKit leverages the capabilities of Apple devices to gather information on participant demographics, health conditions, and other relevant data, facilitating large-scale and remote data collection for scientific research.

Artificial Intelligence in Healthcare

The application of advanced algorithms and machine learning techniques to analyze medical data, support clinical decision-making, improve diagnostics, and enhance patient care delivery.

Augmented Reality (AR) in Healthcare

The use of AR technology, such as smart glasses or headsets, to overlay digital information, images, or 3D models onto the real-world environment, enabling enhanced visualization, surgical guidance, and medical training.

Automated Dispensing Units

Automated machines or systems used in healthcare facilities to store, dispense, and track medications, enhancing medication management, reducing errors, and improving medication distribution efficiency.

AVS - After Visit Summary

After Visit Summary (AVS) is a document provided to patients after a medical visit, typically in outpatient settings. It contains a summary of the visit, including diagnoses, medications prescribed, test results, treatment plans, and any follow-up instructions. AVS helps patients understand and recall the information discussed during the visit, supports continuity of care, and promotes patient engagement in their healthcare.

Bar Code Administration

Bar Code Administration refers to the use of barcodes in healthcare settings to accurately identify and track medical supplies, medications, and patient information. Barcoding systems help improve patient safety, streamline inventory management, reduce medication errors, and enhance the efficiency of various administrative processes in healthcare facilities.

Behavioral Health Integration

The process of incorporating mental health and substance abuse services into primary care settings, aiming to improve access, coordination, and overall healthcare outcomes for patients with behavioral health needs.

Bidirectional Health Information Exchange (BHIE)

A health information exchange system that enables the seamless exchange of patient health information between different healthcare organizations or systems in both directions, facilitating comprehensive and coordinated care.

Bidirectional Interface

A software interface that allows the exchange of data and information between two systems or applications in both directions, enabling real-time data synchronization and communication.

Bioinformatics in Healthcare

Bioinformatics in Healthcare harnesses computational and data analysis methods to interpret vast amounts of biological information, including genomic sequences, molecular structures, and patient health records. By extracting meaningful insights from this data, healthcare professionals can make more informed decisions about disease diagnosis, treatment selection, drug development, and personalized medicine approaches tailored to an individual's genetic and molecular profile.

Biosimilar biological products

Biosimilar biological products are therapeutic substances that are highly similar to and have no clinically meaningful differences from an already approved biological product. Biosimilars are developed to provide more affordable alternatives to complex and expensive biologic medications while ensuring comparable safety, efficacy, and quality. They undergo rigorous testing and regulatory scrutiny to demonstrate similarity to the reference biologic product.

Blockchain

A secure and decentralized digital ledger that can be used to securely store and share healthcare data.

Blue Button Initiative

A U.S. government program that promotes patient access and control over their health information by enabling them to securely download and share their electronic health records, facilitating patient engagement and empowerment.

Brand name (drugs)

Brand name drugs, also known as branded drugs or proprietary drugs, are medications that are marketed and sold under a specific brand or trade name by the pharmaceutical manufacturer. Brand name drugs are typically protected by patents and may have exclusive rights for a certain period, allowing the manufacturer to recoup research and development costs. They are often more expensive than generic drugs, which are copies of the brand name drugs after the patent protection expires.

Bronze health plan

A category of health insurance plan that offers lower monthly premiums but higher deductibles and out-of-pocket costs, typically suited for individuals who anticipate fewer healthcare services or have lower healthcare needs.

Bundled Payments

A payment model where healthcare providers receive a fixed payment for a specific episode of care, covering all the services and treatments related to that episode, promoting care coordination, cost-efficiency, and quality improvement.

Business & clinical intelligence

The use of data analytics and technology to gather, analyze, and interpret healthcare data from both business and clinical perspectives, enabling informed decision-making, performance improvement, and better patient outcomes.

Canceled debts

Canceled debts, also referred to as forgiven or discharged debts, are financial obligations that have been legally forgiven or no longer require repayment. This typically occurs when a lender or creditor agrees to accept a lesser amount than the original debt owed or when the debt is discharged through bankruptcy. In certain situations, canceled debts may be subject to taxation as the forgiven amount is treated as income for the debtor.

Capitation

Capitation in healthcare refers to a payment model where healthcare providers receive a fixed amount of money per patient over a specific period, typically a month or a year. This payment is irrespective of the actual services provided or the complexity of the patients' health conditions. Capitation aims to control costs by incentivizing healthcare providers to deliver efficient and cost-effective care, as they bear the financial risk if the cost of care exceeds the fixed payment. It also encourages preventive care and population health management strategies as providers have an ongoing financial stake in the health outcomes of their patient population.

Care Coordination

The deliberate organization and coordination of healthcare services across different providers, settings, and disciplines to ensure seamless transitions, continuity of care, and effective communication among the healthcare team.

Care Transitions

The movement of patients from one healthcare setting or level of care to another, such as from hospital to home or from primary care to specialty care, requiring careful planning, communication, and coordination to ensure safe and effective transitions.

Catastrophic health plan

A type of health insurance plan that provides coverage for essential health benefits but has higher deductibles and out-of-pocket limits, primarily designed to protect individuals from high medical costs in case of severe illness or injury.

Centers for Medicare & Medicaid Services (CMS)

A federal agency within the US Department of Health and Human Services that administers Medicare, Medicaid, and other healthcare programs.

Certification Commission for Healthcare Information Technology (CCHIT)

A nonprofit organization that was responsible for certifying electronic health record (EHR) systems and promoting interoperability and standards compliance in the healthcare industry.

Chief Information Officer (CIO)

The Chief Information Officer (CIO) is a senior executive responsible for overseeing an organization's information technology (IT) strategy, infrastructure, and systems. The CIO is responsible for aligning IT initiatives with the organization's goals, ensuring data security, managing IT resources and budgets, and driving digital innovation. They play a critical role in leveraging technology to improve operational efficiency, support business growth, and enable digital transformation.

Chief Medical Information Officer (CMIO)

The Chief Medical Information Officer (CMIO) is a physician leader responsible for bridging the gap between clinical operations and information technology within a healthcare organization. The CMIO works closely with the CIO and other stakeholders to develop and implement strategies for effectively utilizing health information technology (HIT) systems, electronic health records (EHRs), and clinical informatics tools to improve patient care, enhance clinical workflows, and optimize health information exchange.

Children's Health Insurance Program (CHIP)

A government program in the United States that provides health insurance coverage to eligible children from low-income families, aiming to ensure access to necessary healthcare services for children.

Chronic Care Management (CCM)

A healthcare model that focuses on managing chronic conditions, such as diabetes and heart disease, through preventive care and disease management.

Chronic disease management

An approach to healthcare that focuses on the ongoing care and support of individuals with chronic conditions, aiming to optimize their health outcomes, enhance self-management skills, and reduce the impact of the disease on their daily lives.

Chronic Disease Prevention

Activities and interventions designed to reduce the occurrence and impact of chronic illnesses through education, lifestyle changes, and early detection.

Claims clearinghouses

Claims clearinghouses are intermediaries in the healthcare billing and reimbursement process. They act as electronic gateways between healthcare providers and insurance payers, facilitating the submission, processing, and adjudication of medical claims. Clearinghouses receive claims from providers, perform data validation, format standardization, and transmit the claims electronically to the appropriate insurance payers for payment processing.

Clinical Applications Analyst

A Clinical Applications Analyst is a professional responsible for analyzing, implementing, and supporting clinical software applications within a healthcare organization. They collaborate with clinicians, IT teams, and vendors to ensure that clinical applications, such as electronic health records (EHRs) or computerized physician order entry (CPOE) systems, meet the needs of healthcare providers and comply with industry standards and regulations.

Clinical Data Repository (CDR)

A centralized database that securely stores and manages patient health records, allowing healthcare providers to access comprehensive patient information, facilitate clinical decision-making, and support research and analytics.

Clinical Data Warehousing

This refers to the process of collecting, storing, and managing large volumes of clinical data from various sources within a healthcare organization. The data can include electronic health records (EHRs), medical images, lab results, and more. Clinical data warehousing allows for efficient data analysis, reporting, and research to support evidence-based healthcare decisions.

Clinical Decision Support (CDS)

Tools and resources used by healthcare providers to assist in making clinical decisions based on evidence-based guidelines and best practices.

Clinical Decision Support Systems

Software and tools that provide healthcare providers with evidence-based information and recommendations to aid in clinical decision-making.

Clinical Decision Support Systems (CDSS)

Computer-based tools and algorithms that provide healthcare professionals with evidence-based recommendations, guidelines, and alerts at the point of care, assisting in diagnosis, treatment planning, and medication management.

Clinical Document Architecture (CDA)

A standardized XML-based format for encoding and exchanging clinical documents, enabling the interoperable exchange of patient information between different healthcare systems and organizations.

Clinical documentation improvement (CDI)

A process aimed at enhancing the quality and accuracy of clinical documentation in health records, ensuring that it adequately reflects the patient's conditions, treatments, and outcomes for effective communication, billing, and research purposes.

Clinical Episode/Encounter

A clinical episode or encounter refers to a specific interaction between a patient and a healthcare provider or facility for the purpose of medical evaluation, treatment, or management. It can include various activities, such as consultations, examinations, procedures, or therapy sessions, that occur during a specific timeframe related to a specific health issue or condition.

Clinical Genomics

Clinical Genomics integrates genomic information into clinical practice to enhance disease diagnosis, risk assessment, and treatment selection. By analyzing an individual's genetic makeup, variations, and mutations, healthcare providers can identify hereditary conditions, predict disease susceptibilities, and tailor medical interventions based on a person's unique genetic characteristics. Clinical Genomics bridges the gap between genetics research and patient care, enabling precision medicine strategies.

Clinical Informatics

Clinical Informatics is a multidisciplinary field that combines healthcare, information technology, and data science to improve patient care, clinical decision-making, and healthcare delivery. It involves the collection, management, analysis, and interpretation of clinical data, and the development and implementation of informatics tools and systems to support evidence-based practice, quality improvement, and healthcare research.

Clinical Integration

The coordination and collaboration among different healthcare providers, settings, and specialties to deliver comprehensive, coordinated, and patient-centered care, optimizing efficiency, quality, and continuity of care.

Clinical intelligence (CI) apps

Clinical Intelligence (CI) apps are software applications or tools that leverage data analytics and information technology to provide actionable insights and support clinical decision-making. These apps utilize algorithms, machine learning, and data visualization techniques to analyze and present clinical data, enabling healthcare professionals to identify trends, patterns, and potential risks or opportunities for improved patient care.

Clinical NLP (Natural Language Processing)

Clinical NLP is a branch of artificial intelligence (AI) that focuses on the analysis and understanding of unstructured clinical text data, such as physician notes and patient narratives. It enables computers to extract valuable information from text, aiding in clinical decision support, research, and data mining.

Clinical Practice Guidelines (CPG)

Evidence-based recommendations for healthcare providers to assist in clinical decision-making and improve patient outcomes.

Clinical Quality Measures (CQMs)

Standardized metrics and indicators used to assess and monitor the quality of healthcare delivery, such as adherence to evidence-based guidelines, patient safety, and outcomes, helping measure and improve the quality of care provided.

Clinical Workflow

Clinical workflow refers to the sequence of tasks, activities, and processes involved in delivering patient care within a healthcare setting. It encompasses the movement of patients, information, and resources, as well as the coordination and collaboration among healthcare providers and departments. Optimizing clinical workflows aims to enhance efficiency, reduce errors, and improve the overall quality and safety of patient care.

Cloud-based EHRs

Electronic Health Record (EHR) systems that are hosted and accessed through cloud computing platforms, offering flexibility, scalability, and remote accessibility for healthcare providers and organizations.

CMIO (Chief Medical Information Officer)

A senior healthcare executive responsible for overseeing the implementation, management, and optimization of health information technology systems, such as electronic health records (EHRs), within a healthcare organization.

COBRA

COBRA, an acronym for Consolidated Omnibus Budget Reconciliation Act, is a U.S. federal law that provides certain employees and their dependents the option to continue their group health insurance coverage after a qualifying event, such as job loss or reduction in work hours. Under COBRA, individuals may be eligible to maintain their previous health insurance coverage for a limited period, although they may be responsible for the full premium cost.

Coinsurance

Coinsurance is a cost-sharing arrangement in health insurance where the insured individual is responsible for paying a certain percentage of the covered medical expenses after the deductible has been met. For example, if a health insurance plan has a coinsurance rate of 20%, the individual would pay 20% of the allowed amount for a covered service, while the insurance company would cover the remaining 80%.

Community rating

Community rating is a method used by health insurance companies to set premiums based on the average risk or cost of providing coverage to a particular community or population. Under community rating, insurance premiums are not adjusted based on an individual's health status, age, or other factors, but are instead calculated on a community-wide basis. This helps ensure that individuals with pre-existing conditions or higher healthcare needs are not charged significantly higher premiums.

Comorbidities

Comorbidities refer to the presence of one or more additional diseases or medical conditions alongside a primary condition in an individual. Comorbidities can influence the diagnosis, treatment, prognosis, and management of the primary condition, as they may interact or impact each other. Understanding and managing comorbidities is important in healthcare to ensure comprehensive and personalized care for individuals with complex health needs.

Comparative Effectiveness Research (CER)

The study of various medical interventions to determine which treatments and approaches are most effective for specific patient populations, helping inform healthcare decision-making and improve patient outcomes.

Computer-assisted coding (CAC)

Computer-assisted coding (CAC) is a technology-driven process that supports healthcare providers in assigning appropriate medical codes to diagnoses, procedures, and services. CAC systems analyze clinical documentation, such as electronic health records (EHRs), and suggest or automate the coding process, helping to improve accuracy, efficiency, and compliance with coding standards and regulations.

Computer-assisted coding system (CACS)

A computer-assisted coding system (CACS) is software that utilizes natural language processing (NLP) and artificial intelligence (AI) algorithms to assist healthcare professionals in assigning appropriate medical codes to clinical documentation. CACS can analyze and interpret unstructured clinical data, such as physician notes or radiology reports, and suggest or automate the coding process, improving coding accuracy and efficiency.

Computerized practitioner order entry (CPOE)

Computerized practitioner order entry (CPOE) is a system that allows healthcare providers to enter and manage patient care instructions electronically. CPOE eliminates the need for paper-based orders and enhances the accuracy and efficiency of order entry, reducing the risk of errors and improving patient safety. It enables healthcare professionals to electronically prescribe medications, order tests, and request procedures, among other functions.

Computerized Provider Order Entry (CPOE)

Computerized Provider Order Entry (CPOE) is a system that enables healthcare providers to enter and manage patient care instructions electronically, replacing traditional paper-based ordering methods. CPOE systems help streamline the ordering process, reduce errors, and improve patient safety by providing decision support, standardized order sets, and electronic transmission of orders to the appropriate departments or personnel.

Consolidated Health Informatics (CHI) Initiative

A collaborative effort among federal agencies in the United States to promote the standardization and interoperability of health informatics and health IT systems, ensuring seamless data exchange and information sharing across the healthcare landscape.

Consumer-Directed Health Plans (CDHPs)

Health insurance plans that offer individuals more control and decision-making power over their healthcare spending, typically combining high-deductible health plans with health savings accounts (HSAs) or health reimbursement arrangements (HRAs).

Continuity of Care Document (CCD)

A standard format for exchanging healthcare data between different providers and organizations.

Continuity of Care Record (CCR)

A standardized electronic document that contains essential patient health information, enabling the exchange of crucial clinical data between different healthcare providers and systems to ensure continuity of care during transitions.

Continuous Glucose Monitoring (CGM)

Continuous Glucose Monitoring involves using wearable sensors to track a person's blood glucose levels in real time. This technology is particularly beneficial for individuals with diabetes, as it provides a continuous stream of data, allowing them to monitor how their glucose levels respond to food, physical activity, and medications. CGM systems offer insights that help individuals manage their diabetes more effectively and make informed adjustments to their treatment plans.

Continuum of Care

An integrated system of healthcare services that spans across different levels of care, from preventive and primary care to specialized care, with a focus on coordination, collaboration, and smooth transitions for patients.

Critical Access Hospitals

Critical Access Hospitals are small healthcare facilities located in rural areas that play a crucial role in providing essential medical services to underserved populations. Due to their proximity to remote communities, these hospitals offer emergency care, outpatient services, and limited inpatient treatment. Critical Access Hospitals ensure that residents in remote regions have access to timely medical attention and necessary treatments.

Cultural Competency in Healthcare

Cultural Competency in Healthcare refers to healthcare providers' ability to understand and effectively interact with patients from diverse cultural backgrounds. This involves acknowledging and respecting patients' cultural beliefs, values, and preferences while delivering care. Healthcare professionals with cultural competency skills can offer more patient-centered care, improve communication, build trust, and reduce health disparities among different populations.

Current Procedural Terminology (CPT) Code

A standardized medical code set used to describe medical procedures and services provided by healthcare professionals. CPT codes are maintained and published by the American Medical Association (AMA) and are widely used for billing, reporting, and reimbursement purposes in healthcare. Each CPT code corresponds to a specific medical procedure, treatment, or service.

Cybersecurity in Medical Devices

Measures and protocols put in place to safeguard medical devices, including equipment and software, from cyber threats and unauthorized access, in order to maintain patient safety and data privacy.

Data Privacy in Telemedicine

Data Privacy in Telemedicine focuses on safeguarding patient confidentiality and protecting sensitive health information when using telemedicine technologies for remote consultations. It involves implementing secure communication channels, encrypted data transmission, and robust authentication mechanisms to ensure that patient data remains private and protected during virtual medical interactions.

Decision-Support System (DSS)

A Decision-Support System (DSS) is a computer-based tool or software application that assists individuals or organizations in making informed decisions. In healthcare, DSS utilizes data analytics, algorithms, and predictive models to provide evidence-based recommendations, alerts, or insights to healthcare professionals. DSS can aid in clinical decision-making, resource allocation, and strategic planning, among other applications.

Department of Health and Human Services (HHS)

A U.S. government department responsible for promoting the health and well-being of Americans by overseeing various healthcare and social services programs, policies, and regulations.

Diagnostic Related Group (DRG)

A classification system used by Medicare and other insurers to determine payment for hospital services based on the patient's diagnosis.

Digital Biomarkers

Digital Biomarkers are quantifiable measurements collected from digital health devices and wearables, such as heart rate monitors, activity trackers, and smartwatches. These biomarkers provide objective data about an individual's health status, behavior patterns, and physiological responses. By analyzing digital biomarkers, healthcare professionals can gain insights into a person's well-being, monitor chronic conditions, and make data-driven decisions for diagnoses and interventions.

Digital Health Innovations

Technological advancements and solutions designed to enhance healthcare delivery, diagnostics, treatment, and patient engagement through digital platforms and tools.

Digital Health Records

Digital Health Records (DHRs) are electronic versions of a patient's medical history, diagnoses, medications, and treatment plans. They are accessible to authorized healthcare providers and often integrated with electronic health record (EHR) systems. DHRs streamline healthcare workflows, improve data accuracy, and enhance patient care.

Digital Imaging and Communications in Medicine (DICOM)

A standard for storing, transmitting, and sharing medical images and related information, ensuring compatibility and interoperability between different medical imaging devices and systems.

Digital Therapeutics

Software-based interventions, typically delivered through mobile applications or web platforms, that aim to prevent, manage, or treat medical conditions, often used in conjunction with traditional medical treatments.

Direct-to-Consumer Advertising (DTCA)

The promotion and marketing of healthcare products or services directly to consumers through various channels, such as television, print media, and online platforms, to raise awareness and influence consumer behavior.

Disease management

Disease management refers to a systematic approach to managing chronic diseases or conditions with the goal of improving health outcomes, reducing healthcare costs, and enhancing the quality of life for individuals. It involves coordinated efforts by healthcare providers, patients, and other stakeholders to provide comprehensive care, education, self-management support, and regular monitoring to individuals with chronic conditions.

DMEs (Durable Medical Equipment)

Durable Medical Equipment (DMEs) are medical devices and equipment prescribed by healthcare providers to aid in the treatment and management of medical conditions. Examples include wheelchairs, crutches, oxygen tanks, and CPAP machines.

Donut hole (Medicare prescription drug)

A coverage gap in Medicare Part D prescription drug plans, where beneficiaries may experience higher out-of-pocket costs for prescription drugs until they reach a certain spending threshold, after which catastrophic coverage kicks in.

Drug list

A drug list, also known as a formulary, is a list of prescription medications that are covered by a specific health insurance plan or pharmacy benefit program. The list includes information on drug names, dosage forms, coverage tiers, and any restrictions or requirements, such as prior authorization or step therapy. Drug lists help individuals and healthcare providers understand which medications are covered and the associated cost-sharing requirements.

Drug Utilization Review (DUR)

Drug Utilization Review involves assessing prescription drug use to ensure that medications are prescribed, dispensed, and administered appropriately. This process helps prevent medication errors, adverse drug reactions, and unnecessary drug interactions. Pharmacists and healthcare professionals analyze patients' medication histories to identify potential issues, improve medication adherence, and optimize therapeutic outcomes.

Durable medical equipment (DME)

Durable medical equipment (DME) refers to medical devices, equipment, or supplies that are prescribed by healthcare providers for use at home or in healthcare facilities to aid in the diagnosis, treatment, or management of medical conditions. Examples of DME include wheelchairs, crutches, oxygen equipment, and diabetic supplies. DME is designed to withstand repeated use and is primarily used for medical purposes.

Early and Periodic Screening, Diagnostic, and Treatment Services (EPSDT)

Early and Periodic Screening, Diagnostic, and Treatment Services (EPSDT) is a comprehensive child health program provided under Medicaid in the United States. EPSDT aims to ensure that eligible children receive appropriate preventive, diagnostic, and treatment services to address physical, developmental, behavioral, and dental needs. EPSDT covers a wide range of services, including regular check-ups, immunizations, screenings, and necessary treatment.

eHealth Ethics

eHealth Ethics addresses ethical considerations in the use of electronic health records (EHRs), telemedicine, and other digital health technologies. It encompasses principles of patient consent, data security, confidentiality, and responsible data sharing to ensure that patient rights and privacy are upheld as healthcare becomes more technologically integrated.

EHR certification

EHR certification refers to the process of evaluating and verifying that electronic health record (EHR) systems meet specific criteria and standards set by regulatory bodies or certification organizations. EHR certification ensures that the EHR systems adhere to recognized industry standards for data security, interoperability, privacy, and functionality, enabling healthcare providers to meet meaningful use requirements and qualify for incentive programs.

EHR Optimization Strategies

Approaches aimed at improving the efficiency, usability, and effectiveness of electronic health record (EHR) systems to enhance patient care.

EHR security

EHR security refers to the measures and practices implemented to protect electronic health records (EHRs) and the sensitive patient information they contain. It includes safeguards such as access controls, data encryption, audit trails, and authentication protocols to prevent unauthorized access, breaches, or misuse of patient data. EHR security is crucial to maintain patient privacy, comply with data protection regulations, and mitigate the risk of data breaches or identity theft.

eICU and telestroke

eICU and telestroke are telemedicine services that leverage technology to provide remote monitoring and consultations for intensive care unit (ICU) patients and stroke patients, respectively. eICU enables critical care specialists to remotely monitor patients in multiple ICUs, providing real-time clinical insights, early intervention, and support to on-site care teams. Telestroke allows neurologists to assess and consult on stroke cases remotely, facilitating timely evaluation and treatment decisions for patients in underserved areas.

Electronic Claim

An electronic claim, also known as an e-claim, is a digital submission of a healthcare provider's request for payment to an insurance payer or a clearinghouse. Electronic claims replace paper-based claim forms and are transmitted electronically, improving efficiency, accuracy, and timeliness of claim processing. They typically include details such as patient information, diagnosis codes, procedure codes, and itemized services rendered.

Electronic Health Record (EHR)

A digital version of a patient's medical history, which can be accessed and shared by healthcare providers and organizations.

Electronic Health Record (EHR) Incentive Programs

Programs initiated by the Centers for Medicare & Medicaid Services (CMS) to provide financial incentives to eligible healthcare professionals and hospitals that demonstrate meaningful use of EHRs to enhance patient care and outcomes.

Electronic Health Record (EHR) Interoperability

EHR Interoperability refers to the seamless exchange of patient health information across different electronic health record systems. This capability allows healthcare providers to access and share vital patient data securely and efficiently, regardless of the EHR platform being used. Interoperability improves care coordination, reduces duplicate tests, and enhances patient outcomes by providing a comprehensive view of a patient's medical history.

Electronic Intensive Care Unit (eICU)

An Electronic Intensive Care Unit (eICU) is a remote monitoring system that uses advanced technology and telecommunication to provide round-the-clock critical care oversight to patients in multiple ICUs. eICU connects off-site critical care teams with on-site care teams, enabling real-time monitoring of patient vital signs, alarms, and electronic health records. It enhances patient safety, improves clinical decision-making, and supports timely intervention and care coordination.

Electronic Medical Record (EMR)

A digital version of a patient's medical record that is maintained by a single healthcare organization.

Electronic payment posting and funds transfer

The electronic processing of healthcare payments and the transfer of funds between payers, providers, and other stakeholders, streamlining payment processes and reducing administrative burdens associated with manual payment posting.

Electronic Prescribing (e-Prescribing)

The use of digital technology to create and transmit prescription orders to pharmacies.

Electronic Prescribing of Controlled Substances (EPCS)

The secure and electronic transmission of prescriptions for controlled substances, such as opioids, to pharmacies, enabling more efficient and accurate medication prescribing, monitoring, and dispensing.

Electronic Signature

An electronic signature refers to a digital representation of an individual's signature that is used to authenticate or validate electronic documents, agreements, or transactions. Electronic signatures are created using cryptographic technology and can be legally binding in many jurisdictions, provided they meet specific requirements for authentication, integrity, and non-repudiation. They offer convenience, efficiency, and security in electronic document management and exchange.

Eligibility assessment

Eligibility assessment is the process of determining an individual's eligibility or qualification for specific benefits, services, or programs. In healthcare, eligibility assessment is often conducted to determine an individual's eligibility for public health insurance programs, such as Medicaid or the Children's Health Insurance Program (CHIP). It involves verifying income, residency, age, immigration status, and other criteria to determine eligibility for coverage and benefits.

Eligible immigration status

Eligible immigration status refers to a legal immigration status that qualifies an individual for certain benefits, including access to health insurance programs or healthcare services. The specific eligible immigration statuses may vary depending on the country and the specific healthcare program or service being considered.

Emergency medical condition

An emergency medical condition refers to a medical condition characterized by severe symptoms, acute onset, or the presence of a life-threatening situation that requires immediate medical attention. It may include conditions such as heart attack, stroke, severe bleeding, respiratory distress, or severe injuries. Emergency medical conditions often require urgent care in an emergency department to stabilize the patient's condition.

Emergency Medical Services (EMS)

Emergency Medical Services encompass a network of professionals, equipment, and resources dedicated to providing rapid and effective medical care during emergencies, accidents, and critical situations. EMS teams include paramedics, EMTs (Emergency Medical Technicians), and first responders who provide immediate medical attention, stabilization, and transport to medical facilities for further treatment.

Emergency medical transportation

Emergency medical transportation, also known as ambulance services, refers to the transportation of patients in critical or life-threatening conditions from the scene of an emergency or a healthcare facility to a medical facility where they can receive appropriate care. Emergency medical transportation is provided by trained medical professionals in specialized vehicles equipped with necessary equipment and supplies to support patients during transport.

Emergency room care

Emergency room care, also known as emergency department (ED) care, refers to the medical evaluation, treatment, and management of patients with urgent or life-threatening conditions in a hospital's emergency department. Emergency room care aims to provide immediate medical attention, stabilize patients, perform diagnostic tests, and initiate necessary interventions to address the urgent healthcare needs of individuals.

Emergency services

Emergency services encompass a range of medical, paramedical, and support services that are available to respond to emergency situations, injuries, or sudden illness. They may include emergency medical technicians (EMTs), paramedics, ambulances, fire departments, police departments, emergency hotlines, and emergency medical facilities. Emergency services play a crucial role in providing immediate care, rapid response, and transportation in emergency situations.

Employer shared responsibility payment (ESRP)

The Employer Shared Responsibility Payment, also known as the Employer Mandate or "Play or Pay" provision, is a requirement under the Affordable Care Act (ACA) in the United States. It mandates that certain large employers (those with 50 or more full-time equivalent employees) must offer affordable and minimum essential health insurance coverage to their full-time employees and their dependents. Failure to provide such coverage may result in the employer being subject to a penalty, known as the Employer Shared Responsibility Payment.

Enterprise Architecture

Enterprise Architecture (EA) is a conceptual framework that defines an organization's structure, processes, information technology (IT) assets, and business strategies. It helps align business goals with IT strategies and facilitates the integration, standardization, and optimization of IT systems across an organization. Enterprise Architecture enables effective decision-making, promotes efficiency, and ensures the overall coherence of an organization's IT landscape.

Enterprise Master Patient Index (EMPI)

The Enterprise Master Patient Index is a centralized database or system used in healthcare organizations to maintain a unique and accurate record of patient identities across various applications and databases. EMPI helps prevent duplicate patient records and improves data integrity by linking multiple records to a single patient, regardless of variations in demographic information or identifiers.

Episode of Care

A defined period during which a patient receives healthcare services related to a specific condition, procedure, or event, including pre-operative, intra-operative, and post-operative care, focusing on coordinated and efficient care delivery.

Essential health benefits

Essential Health Benefits (EHB) refer to a set of minimum healthcare services that health insurance plans in the United States are required to cover under the Affordable Care Act (ACA). These benefits include services such as preventive care, hospitalization, prescription drugs, maternity care, mental health services, and more. EHBs ensure that health insurance plans offer comprehensive coverage to individuals and families.

E-Visit

An E-Visit, also known as an electronic visit or virtual visit, is a healthcare consultation conducted remotely through secure communication technologies, such as video conferencing or telemedicine platforms. E-Visits allow patients to connect with healthcare providers for minor or follow-up medical issues without the need for an in-person visit, providing convenience and accessibility to medical care.

Exchange

The Exchange, also known as the Health Insurance Marketplace in the United States, is an online platform established under the Affordable Care Act (ACA) where individuals, families, and small businesses can shop for and purchase health insurance plans. Exchanges offer standardized and regulated health insurance options, often with subsidies to make coverage more affordable for eligible individuals.

Excluded services

Excluded services refer to healthcare services or treatments that are not covered by a health insurance plan. These services may not be considered medically necessary or may be explicitly excluded from coverage due to specific policy restrictions or limitations.

Exclusive Provider Organization (EPO) Plan

An Exclusive Provider Organization (EPO) Plan is a type of managed care health insurance plan that offers a network of healthcare providers who agree to provide services to plan members at pre-negotiated rates. Unlike a Preferred Provider Organization (PPO), an EPO generally does not provide coverage for out-of-network services, except in emergencies or other limited circumstances.

Exemption

An exemption is a special consideration or exception granted to an individual or entity, exempting them from a certain requirement or obligation. In the context of healthcare, exemptions may be granted for various purposes, such as exempting individuals from the requirement to have health insurance under certain circumstances.

Exemption Certificate Number (ECN)

An Exemption Certificate Number (ECN) is a unique identifier given to individuals who are exempt from the mandate to have health insurance, typically under the Affordable Care Act (ACA) in the United States. It serves as proof of exemption when filing taxes or applying for health insurance coverage.

External review

External review, also known as an independent external review, is a process in which an impartial third party reviews a denied health insurance claim or a health plan's decision. The goal of external review is to ensure that the denial or decision was made appropriately and in compliance with the plan's terms, conditions, and applicable laws.

Family and Medical Leave Act (FMLA)

The Family and Medical Leave Act is a U.S. federal law that allows eligible employees to take unpaid leave for certain family or medical reasons, such as the birth or adoption of a child, caring for a seriously ill family member, or recovering from a serious health condition. FMLA provides job protection and continuation of health insurance coverage during the leave period.

Fast Healthcare Interoperability Resources (FHIR)

A standard for exchanging healthcare data using modern web-based technologies.

FDA - Food and Drug Administration

The Food and Drug Administration (FDA) is a regulatory agency of the United States government responsible for protecting public health by regulating and supervising food safety, pharmaceutical drugs, medical devices, vaccines, biologics, and other health-related products. The FDA reviews and approves new drugs and medical treatments, monitors product safety, and enforces regulations to ensure product quality and efficacy.

FDA (Food and Drug Administration) Regulations of mHealth technologies

Guidelines and regulations established by the FDA to ensure the safety, efficacy, and quality of mobile health technologies, including mobile apps and wearable devices.

Federal Health Architecture (FHA)

An initiative led by the U.S. Office of the National Coordinator for Health Information Technology (ONC) to promote the development and implementation of interoperable health IT systems and standards across federal healthcare agencies.

Federal poverty level (FPL)

The Federal Poverty Level is a set income threshold established by the U.S. government to determine eligibility for certain social welfare programs, including Medicaid and the Affordable Care Act (ACA) subsidies. It serves as a basis for assessing an individual or family's income relative to the national poverty line to determine eligibility for various assistance programs.

Federally Qualified Health Center (FQHC)

Community-based healthcare facilities that provide comprehensive primary care, preventive services, and other healthcare services to underserved populations, often operating on a sliding fee scale.

Federally recognized tribe

A Federally Recognized Tribe refers to a Native American or Alaskan Native tribal community or group that is recognized by the federal government of the United States. Recognition as a federally recognized tribe provides access to specific government benefits, services, and programs, including healthcare services.

Fee

A fee is a charge or payment made for a particular service or privilege. In the context of healthcare, fees may refer to charges for medical services, procedures, consultations, or any other healthcare-related activities.

Fee-for-Service

A healthcare payment model in which providers are paid for each service they provide to a patient.

Flat File Database

A Flat File Database is a type of database that stores data in a plain text file with a specific format, where each line of the file represents a record, and each data field is separated by a delimiter (e.g., comma or tab). Unlike relational databases, flat file databases do not have structured relationships between data elements.

Flexible benefits plan

A Flexible Benefits Plan, also known as a cafeteria plan or a flexible spending arrangement, is an employee benefit plan that allows employees to choose from a selection of pre-tax benefits or cash options. These benefits may include health insurance, retirement savings, life insurance, and other voluntary benefits. Employees can tailor their benefit selections to meet their individual needs and preferences.

Flexible Spending Account (FSA)

A Flexible Spending Account is a tax-advantaged financial account offered by employers that allows employees to set aside pre-tax dollars to pay for eligible healthcare expenses, such as copayments, deductibles, prescription medications, and qualified medical supplies. FSAs help individuals save money on healthcare costs by reducing their taxable income.

Formulary

A Formulary is a list of prescription medications approved by a health insurance plan or pharmacy benefit program. It categorizes medications into different tiers based on their cost and preferred status. Formularies help guide healthcare providers and patients in selecting cost-effective medications while promoting the use of drugs that offer the most value in terms of safety, efficacy, and cost.

Front Office/Back Office

Front Office and Back Office are terms used to describe different areas or functions within a healthcare facility or organization. Front Office typically refers to the patient-facing areas, such as reception, appointment scheduling, and patient registration. Back Office, on the other hand, involves non-patient-facing administrative and support functions, such as billing, coding, and medical record keeping.

FTP – File Transfer Protocol

File Transfer Protocol (FTP) is a standard network protocol used to transfer files from one host to another over a TCP-based network, such as the internet. FTP allows users to upload, download, and manage files on a remote server or computer system.

Full-time employee (FTE)

A Full-time Employee (FTE) is an individual who works the standard or expected number of hours per week or month required by an employer to be considered a full-time employee. The definition of full-time employment may vary by country or employer, but it typically involves a standard number of working hours, often 35 to 40 hours per week.

Fully insured job-based plan

A Fully Insured Job-Based Plan is a type of health insurance plan where the employer pays premiums to an insurance company to cover the employees and their dependents. In a fully insured plan, the insurance company assumes the financial risk and responsibility for paying healthcare claims, while the employer may share the costs with employees through deductibles, copayments, and coinsurance.

General Data Protection Regulation (GDPR)

The General Data Protection Regulation is a comprehensive data protection and privacy law adopted by the European Union (EU) to regulate the processing and handling of personal data of EU residents. GDPR imposes strict requirements on businesses and organizations that handle personal data, including consent requirements, data breach notification, data subject rights, and penalties for non-compliance.

Generic drugs

Generic drugs are pharmaceutical products that are bioequivalent to brand-name drugs in terms of active ingredients, dosage form, strength, route of administration, and intended use. Generic drugs are typically more affordable than brand-name drugs, as they are marketed after the expiration of the brand-name drug's patent. They undergo rigorous testing and approval processes to ensure safety and efficacy.

Genomic Data Sharing

Genomic Data Sharing involves the responsible exchange of genetic and genomic information among researchers, healthcare providers, and institutions. By sharing this data, the scientific community can collaboratively advance our understanding of genetics, disease mechanisms, and personalized treatments. Genomic data sharing supports discoveries, enables precision medicine, and contributes to the development of targeted therapies.

Genomic sequencing

Genomic sequencing is a laboratory technique used to analyze and determine the complete DNA sequence of an organism, including humans. It provides detailed information about an individual's genetic makeup, including potential genetic variations or mutations that may be relevant to health and disease. Genomic sequencing has applications in personalized medicine, disease diagnosis, and genetic research.

Global Health Diplomacy

Global Health Diplomacy refers to international collaboration and negotiation efforts aimed at addressing global health challenges, fostering cooperation among nations, and improving healthcare policies and practices. It involves diplomatic approaches to tackle issues such as disease outbreaks, health inequalities, and healthcare system strengthening on a global scale.

Gold health plan

Gold Health Plan is a designation used in health insurance exchanges or marketplaces to categorize health insurance plans based on their actuarial value. Gold plans have an actuarial value of approximately 80%, meaning they are expected to cover about 80% of an average individual's healthcare costs, with the remaining 20% paid by the insured through deductibles, copayments, and coinsurance.

Google Fit

Google Fit is a health and fitness platform developed by Google that allows users to track and monitor their physical activity, exercise, and wellness data. It integrates with various fitness trackers, wearables, and mobile apps to provide users with insights into their daily activity levels, exercise routines, and health-related goals.

Grace period

A Grace Period is a specified period after a due date during which a payment can be made without incurring penalties or adverse consequences. In healthcare insurance, a grace period may refer to a period of time after the premium due date during which an individual's coverage remains in effect, even if the premium payment is not received on time.

Grandfathered health plan

A Grandfathered Health Plan is a health insurance plan that was in existence before the Affordable Care Act (ACA) was enacted in the United States on March 23, 2010. Grandfathered plans are exempt from certain ACA provisions and requirements, but they must still comply with other consumer protection provisions. These plans may have certain benefits and features that are not available in newer ACA-compliant plans.

Grievance

A Grievance is a formal complaint or expression of dissatisfaction raised by a patient or a healthcare provider regarding the quality of care, treatment, or services received within a healthcare facility or insurance plan. Grievance processes allow individuals to seek resolution or redress for issues related to healthcare services or benefits.

Group health plan

A Group Health Plan is a health insurance plan provided by an employer or an organization to cover a group of individuals, typically employees and their eligible dependents. Group health plans offer benefits to a collective group, often with more favorable terms and rates than individual health insurance plans.

Guaranteed issue

Guaranteed Issue is a regulation that requires health insurance plans to accept all applicants without considering their health status, medical history, or pre-existing conditions. In guaranteed issue markets, individuals cannot be denied coverage based on their health conditions, ensuring access to health insurance for everyone.

Guaranteed renewal

Guaranteed Renewal is a provision in health insurance contracts that guarantees the policyholder the right to renew their health insurance coverage at the end of each policy term. The insurer cannot cancel the policy as long as the policyholder pays the premiums and complies with the terms and conditions of the policy.

H&P (History and Physical)

H&P, which stands for History and Physical, refers to a medical assessment conducted by a healthcare provider to gather information about a patient's medical history, current health status, and physical examination findings. The H&P is a crucial component of the patient's medical record and serves as a basis for formulating a diagnosis, treatment plan, and ongoing medical care.

Habilitative/Habilitation services

Habilitative services refer to a range of therapies, interventions, and support services designed to help individuals develop or acquire functional skills and abilities necessary to enhance their independence and quality of life. These services are often provided to individuals with developmental disabilities, injuries, or health conditions that require skill-building and adaptation to achieve maximum potential in daily activities.

Hardship exemption

A hardship exemption is a special consideration or exemption from certain requirements, such as the mandate to have health insurance coverage, granted to individuals who face significant financial or personal hardships. Hardship exemptions allow individuals to avoid penalties for non-compliance with certain health insurance requirements.

Health care workforce incentive

Health care workforce incentives are programs, initiatives, or financial incentives aimed at attracting, retaining, and incentivizing healthcare professionals to work in underserved or critical need areas. These incentives may include loan forgiveness, scholarships, grants, or bonuses for healthcare providers who commit to practicing in designated areas with shortages of medical services.

Health coverage

Health coverage refers to the extent to which an individual's medical expenses are covered or paid for by a health insurance plan or another healthcare program. Adequate health coverage helps individuals access medical services and treatments without facing significant financial burdens.

Health Data Analytics

The use of advanced analytics and data mining techniques to extract insights, patterns, and trends from large volumes of healthcare data, supporting population health management, predictive modeling, and quality improvement initiatives.

Health Data Exchange Platforms

Infrastructure and systems that facilitate the secure sharing and exchange of patient health information between healthcare organizations, improving care coordination.

Health Data Interoperability

The ability of different healthcare systems and technologies to exchange, share, and interpret health data accurately and seamlessly to facilitate better patient care.

Health Disparities

Systematic differences in health outcomes, access to healthcare, and quality of care experienced by certain populations, often associated with socioeconomic status, race, ethnicity, or geographic location, requiring targeted interventions to achieve health equity.

Health Employers Data Information Set (HEDIS)

The Health Employers Data Information Set (HEDIS) is a standardized set of performance measures used by health insurance plans and healthcare providers to assess and report on the quality of care and services delivered to patients. HEDIS measures cover various aspects of healthcare, including preventive care, chronic disease management, and patient satisfaction.

Health Equity

The principle of ensuring that everyone has the opportunity to attain their highest level of health, regardless of their social, economic, or demographic background, addressing disparities and promoting fairness in healthcare access and outcomes.

Health Equity Initiatives

Programs and strategies aimed at reducing health disparities and promoting equal access to healthcare services and resources for all individuals, regardless of their socioeconomic or demographic background.

Health Informatics Education

Academic programs and training that prepare individuals to work at the intersection of healthcare and information technology, enabling them to manage health data effectively.

Health Informatics Standards

Health Informatics Standards establish guidelines and protocols for the collection, storage, exchange, and use of health information. These standards ensure consistent data formats, terminologies, and communication methods, enabling accurate and seamless health information exchange across different healthcare systems and technologies.

Health Information Exchange (HIE)

The process of securely exchanging healthcare data between different providers and organizations to improve care coordination and patient outcomes.

Health Information Exchange (HIE) Governance

HIE governance encompasses the policies, procedures, and rules that govern the secure and standardized exchange of patient health information among different healthcare organizations, such as hospitals, clinics, and pharmacies. It ensures that patient data is shared effectively, while safeguarding patient privacy and data security.

Health Information Exchange (HIE) Network

A secure electronic network that enables the sharing and exchange of patient health information across different healthcare organizations, facilitating coordinated care, interoperability, and improved patient outcomes.

Health Information Exchange Adoption

The extent to which healthcare organizations and providers participate in health information exchange networks to securely share patient data for improved care coordination.

Health Information Governance

The framework and practices for managing health-related information in a way that ensures its accuracy, integrity, security, and availability while adhering to regulatory requirements.

Health Information Management (HIM)

Health Information Management involves the organization, maintenance, and protection of patient health records and data. HIM professionals ensure that medical information is accurate, accessible, and secure, supporting effective healthcare delivery, administrative processes, and compliance with legal and regulatory requirements.

Health Information Organization (HIO)

A Health Information Organization (HIO) is an entity or network that facilitates the exchange and sharing of electronic health information among different healthcare organizations, providers, and stakeholders. HIOs play a crucial role in promoting interoperability and improving care coordination by enabling the secure and standardized exchange of patient health data.

Health Information Privacy and Security

The protection of sensitive patient health information and the implementation of policies, procedures, and technologies to ensure confidentiality, integrity, and availability of health data, in compliance with relevant laws and regulations like HIPAA.

Health information service providers (HISPs)

Health Information Service Providers (HISPs) are organizations or entities that provide secure and trusted electronic messaging services to facilitate the exchange of health information, such as medical records, lab results, and other health data, among healthcare providers and patients.

Health Information Technology (HIT)

The use of digital technology to manage and exchange healthcare data and improve healthcare delivery.

Health Information Technology for Economic and Clinical Health (HITECH) Act

The Health Information Technology for Economic and Clinical Health Act, enacted in 2009 as part of the American Recovery and Reinvestment Act, aimed at promoting the adoption and meaningful use of electronic health records (EHRs) and supporting the development of health information exchange infrastructure.

Health insurance

Health insurance is a contract or policy purchased by individuals or employers to provide financial protection against the costs of medical expenses and healthcare services. Health insurance plans may cover a variety of services, including doctor visits, hospitalization, prescription drugs, and preventive care.

Health Insurance Exchange (HIX)

A marketplace where individuals can compare and purchase health insurance plans, often established under the ACA.

Health Insurance Marketplace

An online platform established under the Affordable Care Act (ACA) where individuals and small businesses can compare, select, and enroll in health insurance plans that meet their needs, often with the assistance of subsidies.

Health Insurance Marketplace Navigator

Trained individuals or organizations that provide personalized assistance to individuals, families, and small businesses in navigating the health insurance marketplace, understanding coverage options, and enrolling in appropriate health plans.

Health Insurance Portability and Accountability Act (HIPAA)

A federal law that sets standards for protecting patients' health information and privacy.

Health Insurance Portability and Accountability Act of 1996 (HIPAA)

A federal law in the United States that establishes privacy and security standards for protected health information (PHI) and governs the electronic exchange of healthcare data, aiming to ensure patient confidentiality and data security.

Health Level Seven International (HL7)

An international standard for the exchange of healthcare data between different systems and applications.

Health Literacy

The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make informed healthcare decisions, promoting better health outcomes and patient empowerment.

Health Maintenance Organization (HMO)

A managed care organization that provides comprehensive healthcare services to enrolled members, emphasizing preventive care and requiring members to select a primary care physician who coordinates their care and provides referrals to specialists.

Health plan categories

Health plan categories, also known as metal tiers, are classifications used in health insurance marketplaces to categorize health insurance plans based on their actuarial value. The categories typically include Bronze, Silver, Gold, and Platinum, each representing different levels of coverage and cost-sharing for plan members.

Health Reimbursement Arrangement (HRA)

A Health Reimbursement Arrangement (HRA) is an employer-funded benefit plan that reimburses employees for qualified medical expenses. Employers contribute funds to the HRA, and employees can use these funds to pay for eligible healthcare expenses, such as deductibles, copayments, and certain medical services.

Health Savings Account (HSA)

A tax-advantaged account that can be used to pay for qualified medical expenses, often used in conjunction with a high-deductible health plan.

Health status

Health status refers to an individual's overall health condition, including physical, mental, and social well-being. It reflects the presence or absence of illnesses, injuries, chronic conditions, and risk factors that may impact a person's health and quality of life.

Health Technology Assessment (HTA)

The evaluation of medical technologies, including drugs, devices, procedures, and diagnostic tools, to determine their clinical effectiveness, safety, cost-effectiveness, and impact on healthcare outcomes, guiding policy and reimbursement decisions.

Health Technology Assessment Frameworks

Structured methodologies used to evaluate the effectiveness, safety, and economic impact of healthcare technologies and interventions.

Healthcare API (Application Programming Interface)

APIs in healthcare enable different software applications and systems, such as EHRs, to communicate and share data with each other. They facilitate data exchange, interoperability, and the development of third-party healthcare applications, ultimately improving patient care and system efficiency.

Healthcare Data Analytics Tools

Software and tools that analyze large volumes of healthcare data to uncover insights, patterns, and trends for informed decision-making and improved outcomes.

Healthcare Data Breach Prevention

Healthcare Data Breach Prevention strategies focus on safeguarding patient information and preventing unauthorized access or breaches of electronic health records and sensitive medical data. These measures include encryption, access controls, regular security audits, and employee training to ensure patient privacy and prevent data leaks.

Healthcare Data Privacy Laws

Legal regulations and standards that protect patient health information from unauthorized access, use, or disclosure, such as the Health Insurance Portability and Accountability Act (HIPAA).

Healthcare Data Security Protocols

Established procedures and practices to protect sensitive healthcare data from unauthorized access, breaches, and cyber threats.

Healthcare Data Sharing Agreements

Formal agreements or contracts that outline the terms, conditions, and regulations governing the sharing of patient data between healthcare entities while maintaining patient privacy.

Healthcare Interoperability Framework

It comprises a set of standards, protocols, and technologies that enable different healthcare systems, applications, and devices to seamlessly exchange and interpret health data. Interoperability is vital for ensuring that patient information flows securely and accurately across the healthcare ecosystem.

Healthcare Regulatory Compliance

Adherence to legal and regulatory requirements in the healthcare industry to ensure patient safety, data privacy, and ethical practices.

Healthcare Robotics

Healthcare Robotics integrates robotic technology into medical procedures and patient care. Robots are used for tasks such as surgical assistance, rehabilitation, medication dispensing, and even social interaction with patients, enhancing precision, efficiency, and the quality of care.

HEDIS (Healthcare Effectiveness Data and Information Set)

A comprehensive set of performance measures used to evaluate and compare the quality of care provided by health plans, with a focus on clinical effectiveness, patient safety, and patient experience.

High deductible health plan (HDHP)

A High Deductible Health Plan (HDHP) is a type of health insurance plan with a higher deductible than traditional plans. HDHPs typically have lower monthly premiums but higher out-of-pocket costs before the plan starts to cover medical expenses. They are often paired with Health Savings Accounts (HSAs) to help individuals save for qualified medical expenses tax-free.

High-cost excise tax

High-cost excise tax, also known as the "Cadillac tax," was a provision under the Affordable Care Act (ACA) that would have imposed a tax on high-cost employer-sponsored health plans. However, the implementation of this tax was delayed and ultimately repealed before it could take effect.

High-risk pool plan (state)

High-risk pool plans are state-operated insurance programs designed to provide coverage options for individuals with pre-existing medical conditions who may have difficulty obtaining insurance through traditional markets. These pools aim to offer health insurance to individuals who may be denied coverage or face high premiums due to their health conditions.

HIMSS

The Healthcare Information and Management Systems Society, an international organization that promotes the effective use of information technology and management systems in healthcare to improve patient care, healthcare outcomes, and overall health system performance.

HIPAA Compliance Audits

These audits are conducted to assess and ensure compliance with the Health Insurance Portability and Accountability Act (HIPAA) regulations. HIPAA governs the privacy and security of patients' protected health information (PHI) and sets standards for healthcare organizations and their business associates to protect PHI from unauthorized access and breaches.

HIPAA eligible individual

An individual who meets the criteria defined by the Health Insurance Portability and Accountability Act (HIPAA) for protection of their health information and privacy rights.

Holistic Health Practices

Holistic Health Practices consider an individual's physical, emotional, mental, and spiritual well-being as interconnected aspects of overall health. This approach to healthcare emphasizes treating the whole person rather than just addressing specific symptoms or conditions. Holistic health practices may involve complementary and alternative therapies, lifestyle adjustments, and mind-body interventions to promote wellness.

Home and community-based services (HCBS)

A range of healthcare and supportive services provided to individuals in their homes or community settings to assist with activities of daily living, rehabilitation, and long-term care.

Home Health Care

Medical and non-medical services provided to individuals in their own homes, ranging from skilled nursing and therapy services to assistance with activities of daily living, aimed at promoting independence and avoiding unnecessary hospitalizations.

Home monitoring

Home monitoring, also known as remote patient monitoring, refers to the use of technology and medical devices to monitor a patient's health and vital signs in their home or non-clinical settings. Home monitoring allows healthcare providers to remotely track patients' health conditions and provide timely interventions or adjustments to treatment plans.

Hospice services

Hospice services are a specialized type of medical care provided to terminally ill patients with a life expectancy of six months or less. Hospice care focuses on managing pain, addressing symptoms, and providing emotional support to patients and their families during end-of-life care.

Hospital information system (HIS)

A computerized system used by hospitals and healthcare organizations to manage various aspects of their operations, including patient records, scheduling, billing, and resource management.

Hospital outpatient care

Medical services and treatments provided to patients who do not require overnight hospitalization, including diagnostic tests, surgeries, therapies, and other procedures.

Hospital readmissions

Hospital readmissions refer to instances when a patient is discharged from a hospital and then admitted again within a certain period, often within 30 days, for the same or a related condition. Hospital readmissions are considered a quality measure, and efforts are made to reduce preventable readmissions through improved care coordination and follow-up care.

Hospital-Acquired Infection (HAI)

Infections that patients acquire during their stay in a healthcare facility, often due to lapses in infection control practices, emphasizing the importance of preventive measures to reduce the risk of such infections.

Hospitalization

Hospitalization refers to the admission of a patient to a hospital for medical treatment, observation, or surgical procedures that require an overnight stay or an extended period of care.

Household

A household is a group of people living together in the same dwelling unit and sharing common living arrangements, responsibilities, and resources. In the context of healthcare, household size and income are often used to determine eligibility for certain public health insurance programs.

HPI – History of Present Illness

The History of Present Illness (HPI) is a component of a medical encounter note that includes a detailed description of the patient's current symptoms, their onset, duration, progression, and any associated factors. The HPI provides essential information for diagnosing and treating the patient's medical condition.

Human-Centered Design in Medical Devices

Human-Centered Design prioritizes the user's experience, safety, and usability when designing medical devices. This approach involves understanding user needs, conducting usability testing, and iteratively refining devices to ensure they meet the intended purpose effectively and are accessible to patients and healthcare providers.

ICD-10

The 10th edition of the International Classification of Diseases, a standardized system for coding diagnoses, diseases, and medical procedures used globally in healthcare settings for medical record-keeping, billing, and statistical analysis.

ICD-11

The 11th edition of the International Classification of Diseases, an updated version of the coding system that provides a more detailed and comprehensive classification of diseases, disorders, and related health conditions.

Immunization Registry

An Immunization Registry is a centralized database that tracks and records individuals' vaccination histories. It ensures that healthcare providers have up-to-date information about vaccinations, enabling timely administration of vaccines and accurate records for public health monitoring.

In Person Assistance Personnel Program

The In Person Assistance Personnel Program (IPAP) is a program that provides trained individuals, known as navigators or assisters, to help consumers and small businesses understand and enroll in health insurance plans through the Health Insurance Marketplace or Exchange.

Inclusive Healthcare Design

Inclusive Healthcare Design focuses on creating healthcare environments, facilities, and services that accommodate the diverse needs of all patients, including those with disabilities. It ensures physical accessibility, clear communication, and equitable access to medical care for everyone, regardless of their abilities or challenges.

Inconsistency (data matching issue)

Inconsistency in the context of data matching refers to discrepancies or differences found when comparing data from different sources or records. Inconsistencies may arise in healthcare data management and can affect data accuracy, integrity, and interoperability.

Index (Database Reference)

In the context of databases, an index is a data structure that enhances the speed of data retrieval and query performance. It allows the database system to locate and access specific data more efficiently by creating a reference to the indexed columns.

Individual Coverage Health Reimbursement Arrangement

A type of health benefit arrangement where employers provide employees with a fixed amount of money to purchase individual health insurance coverage, allowing more flexibility and choice for individuals.

Individual health insurance policy

An Individual Health Insurance Policy is a health insurance plan purchased by an individual directly from an insurance company or through the Health Insurance Marketplace. Unlike group health insurance plans, individual policies are not tied to employment and are purchased on a per-person basis.

Informatics Nurse Specialist

An Informatics Nurse Specialist is a nursing professional with expertise in health informatics. These specialists integrate nursing science with technology, managing health information systems, electronic health records, and clinical workflows to enhance patient care and healthcare processes.

In-network coinsurance

In-network coinsurance is the portion of healthcare costs that a covered individual is responsible for paying after meeting the deductible, when receiving services from healthcare providers within the insurance plan's network. The insurance plan covers the remaining portion of the covered expenses, as specified in the policy.

In-network copayment

An In-network Copayment is a fixed amount that a covered individual pays for certain healthcare services when visiting healthcare providers within the insurance plan's network. Copayments are typically lower for in-network providers compared to out-of-network providers.

Inpatient

A patient who is admitted to the hospital for an overnight stay or longer.

Inpatient care

Inpatient care refers to medical treatment and services provided to a patient who is admitted to a hospital or healthcare facility and requires an overnight stay or extended medical supervision.

Insurance co-op

An Insurance Cooperative, also known as a health insurance co-op, is a nonprofit, member-owned organization established to provide health insurance coverage to its members. Co-ops aim to offer more affordable and consumer-oriented insurance options.

Integrated Behavioral Healthcare

Integrated Behavioral Healthcare combines mental health and substance abuse services with primary care. This approach recognizes the interconnectedness of physical and mental health and aims to provide comprehensive and coordinated care for patients' well-being.

Interest

In the context of finance and investment, interest refers to the cost of borrowing money or the return earned on invested funds. In healthcare, interest may also refer to the interest that accumulates on unpaid medical bills or the interest earned on reserves held by healthcare organizations.

Interface Engine

An Interface Engine is a software application or middleware that facilitates the exchange of data between different healthcare systems, such as electronic health record (EHR) systems, laboratory information systems, and billing systems. Interface engines ensure seamless data integration and interoperability across diverse healthcare IT systems.

International Classification of Diseases (ICD)

A system of codes used to classify and report medical diagnoses and procedures.

Internet of Medical Things (IoMT)

The network of interconnected medical devices, sensors, wearables, and other healthcare-related technologies that collect and transmit patient data, enabling remote monitoring, real-time analytics, and personalized care.

Interoperability

The ability of different healthcare systems and applications to exchange and use data in a seamless and secure manner.

Interoperability Standards

Technical specifications and protocols that enable different healthcare systems, applications, and devices to exchange and interpret data accurately and efficiently, facilitating seamless information exchange and care coordination.

Interprofessional Collaboration

Interprofessional Collaboration involves healthcare professionals from various disciplines working together to provide holistic and patient-centered care. Collaborative teams bring diverse expertise to address complex health issues, improve treatment outcomes, and enhance the overall quality of care.

Investment income

Investment income refers to the earnings generated from investments, such as dividends from stocks, interest from bonds, or capital gains from the sale of assets. In healthcare, investment income may be earned by healthcare organizations through the management of financial reserves and investments.

Job-based health plan

A Job-based Health Plan is a health insurance plan offered by an employer to its employees and, in some cases, their dependents. These plans may be fully or partially funded by the employer and typically provide coverage options to eligible employees as part of their employee benefits package.

Laboratory Information System

A Laboratory Information System (LIS) is a software system used in medical laboratories to manage and track patient samples, test results, and laboratory workflows. LIS enhances the efficiency and accuracy of laboratory processes and ensures seamless communication with other healthcare systems.

Large group health plan

A Large Group Health Plan is a health insurance plan offered to large organizations or employers with a significant number of employees. Large group plans are subject to different regulations and requirements compared to small group or individual health plans.

Lawfully present

Lawfully present refers to an individual's legal immigration status, allowing them to reside and remain in a country legally. In the context of healthcare, individuals who are lawfully present may be eligible for certain public health insurance programs or healthcare services.

Leapfrog Group

The Leapfrog Group is an independent, nonprofit organization that assesses and promotes transparency in healthcare quality and safety. The Leapfrog Group assigns safety grades to hospitals and healthcare facilities based on performance measures, aiming to empower patients and purchasers to make informed decisions about their healthcare providers.

Legacy System

A Legacy System is an older computer system, software application, or technology infrastructure that is still in use, despite being outdated or replaced by newer technologies. In healthcare, legacy systems may pose challenges for data interoperability and may require updates or replacement to keep up with modern healthcare IT standards.

Legal Medical Record

The Legal Medical Record refers to the collection of healthcare documentation and patient information that serves as an authoritative source of patient health data and treatment history. The Legal Medical Record is essential for legal and regulatory purposes and must meet specific requirements to maintain data integrity and security.

Lifetime limit

A Lifetime Limit is a cap or maximum dollar amount set by an insurance plan on the total benefits it will pay for an insured individual over their lifetime. Lifetime limits were prohibited by the Affordable Care Act (ACA) for essential health benefits, ensuring that individuals could access necessary medical services without facing benefit caps.

Limited cost sharing plan

A Limited Cost Sharing Plan is a type of health insurance plan that provides coverage for preventive services and certain essential health benefits with no or limited out-of-pocket costs for the insured individual. These plans aim to make preventive care and specific medical services more accessible and affordable for plan members.

LOINC (Logical Observation Identifiers Names and Codes)

LOINC is a universal standard for identifying medical laboratory observations and clinical measurements. It provides a set of codes and names for a wide range of medical tests and observations, allowing for consistent and standardized communication and exchange of clinical data between healthcare systems and laboratories.

Longitudinal Patient Records

Longitudinal Patient Records compile comprehensive health information over time, providing a detailed overview of a patient's medical history, diagnoses, treatments, and outcomes. These records support continuity of care, enable informed decision-making, and enhance care coordination among different healthcare providers.

Long-Term Care (LTC)

A range of services and support provided to individuals with chronic illnesses, disabilities, or cognitive impairments who require assistance with activities of daily living, such as nursing care, rehabilitation, and assistance with medication management.

MACRA (Medicare Access and CHIP Reauthorization Act)

Legislation passed by the US Congress to reform Medicare payment systems and improve healthcare quality by promoting value-based care and alternative payment models for healthcare providers.

Master Patient Index (MPI)

A centralized database or system that maintains a unique identifier for each patient, ensuring accurate patient identification, information exchange, and continuity of care across multiple healthcare providers and systems.

Meaningful Use (MU)

A set of federal standards and guidelines that define the requirements for the use of electronic health records and the exchange of healthcare data.

Meaningful Use (MU) Stage 2

The second phase of the Centers for Medicare & Medicaid Services (CMS) EHR Incentive Programs, focusing on advanced clinical processes, decision support, patient engagement, and health information exchange to promote meaningful use of EHRs.

Meaningful Use (MU) Stage 3

The final phase of the Centers for Medicare & Medicaid Services (CMS) EHR Incentive Programs, which outlines specific criteria that eligible professionals and hospitals must meet to demonstrate meaningful use of EHRs and qualify for incentives.

Medicaid

A joint federal and state program that provides healthcare coverage for individuals and families with low incomes.

Medical Device Integration

The process of connecting and integrating medical devices, such as monitors and diagnostic equipment, with electronic health record systems or other healthcare IT systems to capture and transmit patient data seamlessly.

Medical loss ratio (MLR)

A financial metric used to measure the proportion of health insurance premium revenue that health insurers spend on healthcare services and quality improvement activities, rather than administrative costs or profits.

Medical underwriting

The assessment and evaluation of an individual's medical history, health condition, and risk factors by insurers to determine eligibility, coverage options, and premium rates for health insurance.

Medically necessary

Medically necessary refers to healthcare services or treatments that are considered essential for diagnosing, preventing, or treating a medical condition. For insurance coverage purposes, services must meet the criteria of medical necessity to be eligible for reimbursement.

Medicare

A federal health insurance program that provides coverage for individuals aged 65 and older, as well as those with certain disabilities.

Medicare Advantage (Medicare Part C)

Medicare Advantage, also known as Medicare Part C, is a program offered by private insurance companies that provides Medicare benefits to eligible individuals. Medicare Advantage plans offer additional benefits beyond Original Medicare, often including prescription drug coverage and services like dental and vision care.

Medicare fraud and abuse audits

Medicare fraud and abuse audits are investigations conducted by government agencies, such as the Centers for Medicare & Medicaid Services (CMS) or the Office of Inspector General (OIG), to identify and address instances of fraudulent or abusive billing practices in the Medicare program.

Medicare hospital insurance tax

Medicare hospital insurance tax, also known as the Medicare payroll tax, is a payroll tax imposed on both employees and employers to fund the Medicare Part A program, which provides hospital insurance coverage to eligible individuals.

Medicare Part D

Medicare Part D is the prescription drug coverage program offered by Medicare. It helps eligible beneficiaries access affordable prescription medications through private insurance plans that have been approved by Medicare.

Medicare prescription drug donut hole

The Medicare prescription drug donut hole, also known as the coverage gap, was a temporary gap in Medicare Part D prescription drug coverage. Beneficiaries faced higher out-of-pocket costs for prescription drugs until they reached a certain spending threshold. The coverage gap was gradually closed under the Affordable Care Act (ACA).

Medication Error Prevention

Medication Error Prevention strategies aim to reduce the occurrence of medication errors, which can lead to harmful consequences for patients. These strategies involve processes such as double-checking prescriptions, clear communication among healthcare professionals, proper labeling, and patient education to enhance medication safety.

Member survey results

Member survey results refer to the feedback and responses obtained from individuals enrolled in a health plan or healthcare organization. These surveys help assess member satisfaction, experiences, and preferences to identify areas for improvement in healthcare services.

Merit-Based Incentive Program (MIPS)

A performance-based payment program under Medicare that adjusts physician reimbursement based on quality of care, cost-efficiency, use of electronic health records, and practice improvement activities.

Minimum essential coverage (MEC)

Minimum Essential Coverage (MEC) refers to the type of health insurance coverage that satisfies the individual mandate under the Affordable Care Act (ACA). Individuals who have MEC are considered to have met the requirement to have health insurance coverage or may qualify for an exemption.

Minimum value

Minimum value refers to the level of coverage provided by an employer-sponsored health plan. A health plan meets the minimum value requirement if it covers at least 60% of the total allowed costs of essential health benefits for a standard population.

Mobile Apps for Health

Smartphone or tablet applications that provide health-related information, tools, or services to individuals, enabling self-monitoring, health tracking, medication reminders, and access to telehealth services, enhancing engagement and self-management.

Mobile Health (mHealth)

The use of mobile devices, such as smartphones and tablets, and wireless technologies to support healthcare delivery, patient monitoring, health education, and health management, enhancing access and engagement.

Mobile Health Clinics

Mobile Health Clinics are healthcare facilities on wheels that bring medical services directly to communities, especially those in remote or underserved areas. These clinics offer screenings, vaccinations, basic treatments, and preventive care to improve access to healthcare for individuals who may face geographical or transportation challenges.

Mobile Health Solutions

Mobile applications, wearable devices, and other technologies designed to deliver healthcare services, monitor health conditions, and provide health information to individuals through their smartphones or devices.

Mobile-native EHRs

Mobile-native Electronic Health Records (EHRs) are electronic health record systems specifically designed and optimized for use on mobile devices, such as smartphones and tablets. They offer mobile-friendly interfaces and functionalities to support healthcare providers' productivity and patient care while on the go.

Modified Adjusted Gross Income (MAGI)

Modified Adjusted Gross Income (MAGI) is a calculation used to determine an individual's eligibility for certain government assistance programs, including Medicaid and subsidies for health insurance purchased through the Health Insurance Marketplace.

MRN – Medical Record Number

The Medical Record Number (MRN) is a unique identifier assigned to an individual's medical record within a healthcare facility or system. It serves as a key reference to access and retrieve the patient's medical information and history.

Multi-employer plan

A Multi-Employer Plan is a type of employee benefit plan, such as a pension or health plan, that is jointly sponsored by multiple employers or labor unions. These plans allow employees to receive benefits from multiple employers while maintaining consistent coverage.

Multi-state plan

A Multi-State Plan is a type of health insurance plan offered through the Health Insurance Marketplace that is available in multiple states. These plans are created to increase choice and competition in the health insurance marketplaces.

National Health Service (NHS)

The publicly funded healthcare system in the United Kingdom that provides comprehensive healthcare services to all residents, funded through general taxation and free at the point of service.

National Provider Identifier (NPI)

A unique identification number assigned to healthcare providers by the Centers for Medicare & Medicaid Services.

National Quality Forum (NQF)

A nonprofit organization that sets national standards and measures for healthcare quality and safety, endorsing and promoting evidence-based practices, quality metrics, and performance improvement initiatives.

NDC – National Drug Codes

National Drug Codes (NDC) are unique codes assigned to prescription medications, over-the-counter drugs, and other healthcare products to identify them in pharmacy transactions, insurance claims, and medication records.

Net capital gains

Net capital gains refer to the total profit or income gained from the sale of investments or assets after deducting any capital losses.

Net rental income

Net rental income is the income derived from rental properties after deducting operating expenses, property taxes, and mortgage interest.

Network plan

A Network Plan is a health insurance plan that offers coverage for healthcare services provided by a specific network of healthcare providers and facilities. Insured individuals typically pay less out-of-pocket for in-network services compared to out-of-network services.

Nondiscrimination

Nondiscrimination refers to the principle that individuals should be treated fairly and without prejudice based on factors such as race, color, national origin, sex, age, disability, or any other protected characteristic.

Non-preferred provider

A Non-Preferred Provider is a healthcare provider who is not part of the preferred network of healthcare providers associated with an insurance plan. Insured individuals may incur higher out-of-pocket costs when receiving services from non-preferred providers.

Not yet accredited (health plan)

"Not yet accredited" refers to a health plan or insurance company that has not yet obtained accreditation from a recognized accrediting organization, such as the National Committee for Quality Assurance (NCQA).

Notice

A Notice is a formal communication or written statement that provides information, notification, or instructions to an individual or entity regarding a specific matter. In healthcare, notices may be used to communicate changes to health plans, privacy policies, or billing information.

Nursing Informatics

Nursing Informatics combines nursing knowledge with information technology to enhance patient care, nursing workflows, and healthcare outcomes. Nursing informaticists analyze and optimize the use of technology, electronic records, and data systems to improve patient outcomes and support evidence-based practice.

OASIS Data Set

The OASIS (Outcome and Assessment Information Set) Data Set is a standardized assessment tool used by home health agencies to collect and report data on patients receiving skilled home health services. It helps ensure accurate and consistent assessment of patients' needs and outcomes.

ONC (Office Of The National Coordinator For Health Information Technology)

The Office of the National Coordinator for Health Information Technology (ONC) is a U.S. federal agency responsible for promoting the adoption and use of health information technology to improve healthcare delivery, patient outcomes, and data interoperability.

Open Enrollment Period

The Open Enrollment Period is a specified period during which individuals can enroll in or make changes to their health insurance plans for the upcoming coverage year. It is an opportunity for individuals to select or switch health plans, usually offered annually.

Open Notes Initiative

The Open Notes Initiative encourages healthcare providers to share their clinical notes and medical records directly with patients electronically. This initiative promotes transparency, patient engagement, and better communication between patients and their healthcare providers.

Out-of-network coinsurance

Out-of-network coinsurance is the portion of healthcare costs that a covered individual is responsible for paying when receiving services from healthcare providers outside of the insurance plan's network. The insurance plan covers the remaining portion of the covered expenses at a lower rate compared to in-network providers.

Out-of-network copayment

An Out-of-network Copayment is a fixed amount that a covered individual pays for certain healthcare services when receiving care from providers outside of the insurance plan's network. Copayments for out-of-network services are typically higher than for in-network services.

Out-of-pocket costs

Out-of-pocket costs refer to the expenses that an insured individual must pay directly for healthcare services, medications, or medical supplies, in addition to any insurance premiums. These costs include deductibles, copayments, and coinsurance.

Out-of-pocket estimate

An Out-of-pocket Estimate is a calculation provided to a patient by their healthcare provider or insurer, estimating the expected out-of-pocket costs for a particular medical service or treatment.

Out-of-pocket maximum/limit

The Out-of-pocket Maximum or Limit is the maximum amount an insured individual is required to pay for covered healthcare services in a given period, such as a calendar year. Once this limit is reached, the insurance plan covers all further eligible expenses at 100%.

Outpatient

A patient who receives medical care without being admitted to the hospital, such as through a clinic or urgent care center.

PACS

Picture Archiving and Communication System (PACS) is a medical imaging technology that allows healthcare providers to store, retrieve, and distribute digital images, such as X-rays, MRI, and CT scans, throughout a healthcare facility or network.

PACS/VNA

Picture Archiving and Communication System/Vendor Neutral Archive (PACS/VNA) is an integrated solution that combines PACS functionality with a Vendor Neutral Archive, allowing storage and management of medical images from multiple sources and systems.

Palliative Care Services

Palliative Care Services focus on enhancing the quality of life for patients with serious illnesses by addressing pain management, symptom relief, emotional support, and holistic well-being. These services prioritize patient comfort and provide comprehensive care that considers both physical and emotional needs.

Patient Access and Portals

Digital platforms that allow patients to access and manage their health information, communicate with healthcare providers, schedule appointments, view test results, and engage in self-care activities, empowering patients to take an active role in their healthcare.

Patient Activation

The level to which individuals have the knowledge, skills, and confidence to actively manage their own health and healthcare, promoting self-care, adherence to treatment plans, and better health outcomes.

Patient Advocacy

Patient Advocacy involves healthcare professionals or organizations acting as advocates for patients' rights, needs, and preferences. Advocates ensure that patients' voices are heard, help navigate healthcare systems, and promote fair and respectful treatment within the medical community.

Patient Engagement

The process of involving patients in their own healthcare decisions and treatment plans.

Patient Engagement Platforms

Patient Engagement Platforms use technology to empower patients to actively participate in their healthcare decisions, access health information, communicate with healthcare providers, and manage their well-being. These platforms foster collaboration between patients and providers, promoting shared decision-making and patient-centered care.

Patient Engagement Strategies

Approaches that involve patients actively in their healthcare decisions, treatment plans, and management, resulting in improved outcomes and patient satisfaction.

Patient Protection and Affordable Care Act (ACA)

The Patient Protection and Affordable Care Act, commonly known as ACA or Obamacare, is a comprehensive healthcare reform law enacted in the United States in 2010. It aimed to increase access to healthcare, improve quality, and control costs through various provisions, including the establishment of health insurance marketplaces, expansion of Medicaid, and implementation of consumer protections.

Patient Reported Outcomes (PROs)

Measures of health status, symptoms, quality of life, or treatment outcomes directly reported by patients, capturing their perspectives and experiences, often used in research and evaluating healthcare interventions.

Patient Safety Culture

The shared values, attitudes, beliefs, and practices within a healthcare organization that prioritize patient safety, encourage open communication, reporting of errors, and continuous improvement in safety measures and practices.

Patient-Centered Medical Home (PCMH)

A healthcare model that emphasizes coordinated and patient-centered care, with a focus on preventive care and disease management.

Patient-centered outcomes research

Patient-centered outcomes research focuses on evaluating and comparing various medical treatments and interventions to determine which options best align with patients' preferences, needs, and values. This research aims to guide healthcare decisions based on patient-centered factors and improve patient outcomes and experiences.

Patient-Centric Healthcare Delivery

A care approach that places patients at the center of their healthcare journey, involving them in decisions and tailoring services to their unique needs.

Patient-Generated Health Data (PGHD)

PGHD refers to health data collected by patients themselves, often through wearable devices, mobile apps, or home monitoring tools. This data includes information on physical activity, vital signs, symptoms, and medication adherence. PGHD can provide valuable insights into a patient's health between clinical visits.

Payment bundling

Payment bundling is a reimbursement model that consolidates multiple healthcare services and related costs for a specific episode of care into a single payment. This approach encourages coordination among healthcare providers and promotes cost efficiency.

Personal Health Record (PHR)

A digital tool that allows patients to track and manage their own healthcare data, such as medical history and medication lists.

Pharmacy Informatics

Pharmacy Informatics applies informatics principles to pharmacy practice, optimizing medication management, dispensing, and patient safety. This field leverages technology to streamline medication-related processes, ensure accurate drug dispensing, and prevent adverse drug interactions.

Physician services

Physician services refer to medical care and consultations provided by licensed physicians and healthcare professionals. These services may include diagnosis, treatment, and management of medical conditions.

Platinum health plan

Platinum health plans are a category of health insurance plans available through the Health Insurance Marketplace or Exchange. They typically have higher monthly premiums but offer lower out-of-pocket costs, providing more comprehensive coverage.

Point of Care Test

Point of Care Tests are medical diagnostic tests conducted at or near the location where patient care is provided, offering rapid results to guide immediate medical decisions.

Point of Service (POS) Plans

Point of Service Plans are a type of health insurance plan that allows members to choose between in-network and out-of-network healthcare providers. However, higher out-of-pocket costs may apply for out-of-network care.

Policy year

The Policy Year refers to the duration of a health insurance policy's coverage, typically lasting for one year. It is the period during which the policyholder is entitled to the benefits and protections outlined in the insurance contract.

Population Health

The health outcomes and patterns of health in a defined group or community, including determinants of health, such as social, economic, and environmental factors, and strategies to improve health outcomes for that population.

Population Health Analytics

The analysis of aggregated health data from a specific population to identify patterns, trends, and risk factors, supporting population health management initiatives, disease prevention strategies, and evidence-based decision-making.

Population Health Management (PHM)

The use of data and analytics to improve health outcomes for entire populations, often used in public health initiatives.

Post-Acute Care

Healthcare services provided after an acute hospital stay, including rehabilitation, skilled nursing, home health, and hospice care, aiming to facilitate recovery, functional improvement, and successful transitions back to the community.

Preauthorization

Preauthorization is a process where healthcare providers obtain approval from an insurance company before performing certain medical procedures or services. It ensures that the proposed treatment is covered and medically necessary.

Precision Health Informatics

The field that combines health informatics, genomics, and precision medicine to analyze large-scale healthcare data, genomics data, and patient-specific information to drive personalized healthcare interventions and treatments.

Precision Medicine

An approach to healthcare that tailors medical treatments and interventions to individual patients based on their genetic makeup, lifestyle factors, and environmental influences, aiming to improve treatment outcomes and minimize adverse effects.

Precision Medicine Implementation

The application of precision medicine concepts to clinical practice, tailoring medical treatments and interventions based on individual genetic, environmental, and lifestyle factors.

Precision Oncology

Precision Oncology tailors cancer treatments to an individual's genetic profile, disease characteristics, and response to therapies. By analyzing genomic data, oncologists can identify targeted treatments that maximize effectiveness and minimize side effects, providing more personalized and precise care.

Precision Public Health

The application of precision medicine principles and technologies at the population level to prevent disease, promote health, and optimize healthcare interventions, leveraging genomics, data analytics, and public health strategies.

Predictive modeling

Predictive modeling involves using statistical algorithms and data analysis techniques to forecast future events or outcomes, such as predicting patient health risks or healthcare utilization patterns.

Pre-existing condition

A Pre-existing condition is a medical condition that an individual had before obtaining health insurance coverage. The ACA prohibits health insurance plans from denying coverage or charging higher premiums based on pre-existing conditions.

Pre-existing condition (job-based coverage)

In the context of job-based health coverage, a Pre-existing Condition is a medical condition that existed before an employee enrolled in their employer's health plan. The ACA also prohibits job-based health plans from excluding coverage for pre-existing conditions.

Pre-existing condition exclusion period (individual policy)

The Pre-existing Condition Exclusion Period is a timeframe during which a health insurance policy may not cover certain medical conditions that existed before the policy's start date. However, the ACA prohibits such exclusion periods for individual health insurance policies.

Pre-existing condition exclusion period (job-based coverage)

The Pre-existing Condition Exclusion Period for job-based health coverage refers to the timeframe during which a health insurance plan may not cover certain medical conditions that existed before the individual's enrollment in the plan. However, the ACA prohibits such exclusion periods for job-based health plans.

Pre-existing Condition Insurance Plan (PCIP)

The Pre-existing Condition Insurance Plan (PCIP) was a temporary program established by the ACA to provide health coverage for individuals with pre-existing conditions who were previously denied insurance. The program was replaced by other ACA provisions.

Preferred Provider Organization (PPO)

A type of health insurance plan that allows patients to see both in-network and out-of-network providers, but typically offers lower costs for in-network care.

Premium

A Premium is the amount paid by an individual or employer to purchase health insurance coverage. It is usually paid on a regular basis, such as monthly or annually.

Premium tax credit

The Premium Tax Credit is a subsidy provided by the government to help eligible individuals and families lower the cost of health insurance purchased through the Health Insurance Marketplace.

Prescription drug coverage

Prescription drug coverage refers to the benefits provided by health insurance plans or programs to cover the cost of prescription medications prescribed by healthcare providers.

Prescription Drug Monitoring Program (PDMP)

A statewide electronic database that collects and monitors controlled substance prescription data, helping healthcare providers identify potential cases of misuse, abuse, or diversion.

Prescription drugs

Prescription drugs are medications that can only be obtained with a written prescription from a licensed healthcare provider. These medications may treat various medical conditions and require supervision and monitoring by healthcare professionals.

Prevention

Prevention refers to strategies and interventions aimed at reducing the occurrence of diseases and health conditions by promoting healthy behaviors and early detection of potential health risks.

Preventive services

Preventive services are healthcare interventions, such as vaccinations, screenings, and counseling, designed to detect and prevent illnesses or health conditions before they become more severe or symptomatic.

Primary care

Primary care refers to the first level of healthcare that individuals receive when seeking medical attention for common health problems or preventive services. It is typically provided by family physicians, internists, pediatricians, and nurse practitioners.

Primary Care Access

Primary Care Access ensures timely and consistent availability of essential healthcare services, promoting prevention, early intervention, and ongoing health maintenance. Access to primary care is crucial for managing chronic conditions, addressing acute illnesses, and receiving preventive care.

Primary Care Physician (PCP)

A doctor who provides general medical care to patients and serves as the first point of contact for healthcare needs.

Prior Authorization

A process where healthcare providers must obtain approval from insurance companies before certain medical treatments, procedures, or medications can be covered, ensuring appropriate utilization and cost control.

Protected Health Information (PHI)

Any information that can be used to identify a patient, which is subject to privacy and security regulations under HIPAA.

Protocol Orders

Protocol Orders are standardized medical orders and treatment plans used in specific clinical situations or emergencies. They help ensure uniformity and efficiency in patient care.

Provider Directory

A database of healthcare providers that can be used by patients to find and select providers.

Public health

Public health focuses on protecting and improving the health of populations and communities through disease prevention, health promotion, and health education initiatives.

Public Health Emergency

An event or situation, such as a natural disaster or disease outbreak, that poses a significant risk to public health and requires immediate action, coordination, and resources to protect and safeguard the population.

QRDA (Quality Reporting Document Architecture)

QRDA is a standard format for exchanging electronic clinical quality data between different healthcare systems and organizations. It is used to report quality measures and performance data to regulatory agencies and payers.

QSEHRA (Qualified Small Employer Health Reimbursement Arrangement)

QSEHRA is a type of health reimbursement arrangement that allows small employers to offer tax-free funds to employees for the purchase of individual health insurance or qualified medical expenses.

Qualified health plan

A Qualified Health Plan (QHP) is a health insurance plan that meets the minimum requirements and standards established by the Health Insurance Marketplace or Exchange.

Qualifying health coverage

Qualifying health coverage refers to health insurance plans that meet the minimum essential coverage requirements under the ACA. Individuals with qualifying health coverage are considered compliant with the individual mandate.

Qualifying life event (QLE)

A Qualifying Life Event (QLE) is a significant life change, such as marriage, birth of a child, loss of other health coverage, or a move to a new state, which allows individuals to enroll or make changes to their health insurance outside of the regular enrollment period.

Quality Improvement Organization (QIO)

Organizations contracted by the Centers for Medicare & Medicaid Services (CMS) to work with healthcare providers and communities to improve the quality of care delivered to Medicare beneficiaries and promote patient safety.

Quality measurement and reporting

Quality measurement and reporting refer to the assessment and reporting of healthcare outcomes and performance indicators to monitor and improve the quality of healthcare services provided to patients.

Quality Measures

Standards used to assess and improve the quality of healthcare provided by providers and organizations.

Radiology Information System (RIS)

A Radiology Information System (RIS) is a specialized software system used by radiology departments to manage and store patient radiological data and images.

Radiomics

Radiomics involves extracting quantitative features from medical images, such as CT scans or MRIs, to provide insights into disease characteristics, treatment response, and prognosis. By analyzing radiomic data, healthcare professionals can identify subtle patterns that may not be visible to the naked eye, aiding in diagnostic accuracy and personalized treatment planning.

Readmission

The return of a patient to the hospital within a certain timeframe after being discharged, often used as a metric for hospital quality.

Real Time Eligibility

Real-Time Eligibility refers to the ability to check a patient's insurance eligibility and coverage details in real-time at the point of care, allowing providers to verify insurance information instantly.

Reconcile

In healthcare billing, reconcile refers to the process of comparing and balancing financial records, such as invoices and payments, to ensure accurate and complete financial transactions.

Reconstructive surgery

Reconstructive surgery is a type of surgical procedure performed to restore the form and function of a body part affected by congenital defects, injuries, or medical conditions.

Referral

A Referral is a recommendation by a primary care physician for a patient to see a specialist or receive specific medical services beyond the primary care provider's scope of practice.

Referral tracking

Referral tracking involves monitoring and managing the progress of patient referrals to specialists or other healthcare providers, ensuring timely and appropriate follow-up care.

Regional Health Information Organization (RHIO)

A Regional Health Information Organization (RHIO) is a collaborative entity that facilitates the exchange of electronic health information among healthcare providers and organizations within a specific geographic region.

Registries

Registries are databases or information systems that collect and store specific data on patients with particular medical conditions or characteristics. These registries help track patient outcomes, monitor disease prevalence, and support clinical research.

Rehabilitative/Rehabilitation services

Rehabilitative or Rehabilitation services refer to medical treatments, therapies, and interventions aimed at restoring physical, cognitive, or functional abilities lost due to injury, illness, or disability.

Reinsurance

Reinsurance is a risk management strategy where an insurance company transfers a portion of its risk to another insurer (the reinsurance company) in exchange for a premium. It helps insurance companies mitigate their exposure to large losses.

Relational Database

A Relational Database is a type of database management system that organizes data into tables with predefined relationships between them, facilitating efficient data retrieval and manipulation.

Release of Information

The Release of Information (ROI) is a process through which a healthcare provider obtains the patient's consent to share their protected health information (PHI) with other parties, such as other healthcare providers or insurance companies.

Remote Desktop Protocol (RDP)

Remote Desktop Protocol (RDP) is a technology that allows users to access and control a computer or server remotely over a network.

Remote monitoring

Remote monitoring involves using technology to collect and transmit patient health data from a distance, enabling healthcare providers to monitor and manage patients' conditions remotely.

Remote Monitoring of Chronic Conditions

Remote Monitoring of Chronic Conditions uses technology to track patients' health data from their homes, allowing healthcare providers to remotely monitor conditions like diabetes, hypertension, or heart disease. This approach enables early detection of changes, timely interventions, and more personalized treatment adjustments.

Remote Patient Monitoring (RPM)

The use of technology, such as wearable devices or home-based monitoring systems, to collect and transmit patient data to healthcare providers, enabling remote monitoring, early intervention, and better management of chronic conditions.

Remote Patient Monitoring (RPM) Devices

These are medical devices equipped with sensors and communication capabilities that allow healthcare providers to remotely collect and monitor a patient's health data. RPM devices are often used for patients with chronic conditions, enabling real-time data tracking and timely interventions to manage their health.

Remote Patient Monitoring Solutions

Technologies that enable healthcare providers to remotely monitor and manage patients' health conditions and vital signs, enhancing proactive care and reducing hospitalizations.

Retirement benefit (pension)

A Retirement Benefit, also known as a pension, is a financial benefit paid to retired individuals based on their years of service and contributions made during their working years.

Revenue Cycle Management (RCM)

The process of managing healthcare revenue, including billing, coding, and payment collection.

Risk Adjustment

A method used to account for differences in health status and patient characteristics when assessing and comparing healthcare outcomes or costs, ensuring fair comparisons and appropriate resource allocation.

Risk for Readmission

The Risk for Readmission refers to the likelihood that a recently discharged patient will be readmitted to the hospital within a specific timeframe, often within 30 days.

Risk management tools

Risk management tools are strategies, methodologies, or software applications used to identify, assess, and mitigate risks in various healthcare settings, ensuring patient safety and quality of care.

Risk stratification

Risk stratification involves categorizing patients based on their health risks and medical conditions to tailor personalized care plans and interventions.

Rural Healthcare Delivery

Rural Healthcare Delivery addresses the unique challenges of providing medical services to populations in remote or underserved rural areas. It involves innovative strategies to overcome geographical barriers, ensure access to care, and improve health outcomes for rural residents.

RxNorm

RxNorm is a standardized nomenclature for medications and drug products used in electronic health records and healthcare systems to improve the exchange and understanding of medication-related information.

SBAR

SBAR stands for Situation, Background, Assessment, and Recommendation, which is a standardized communication framework used in healthcare to effectively communicate critical information, especially during patient handoffs or in urgent situations.

Scope of Care

The Scope of Care refers to the range of healthcare services and treatments that a healthcare provider or facility is qualified and authorized to provide.

Second lowest cost Silver plan (SLCSP)

The Second Lowest Cost Silver Plan (SLCSP) is a benchmark health insurance plan used to calculate premium tax credits for individuals and families who purchase insurance through the Health Insurance Marketplace.

Secure messaging

Secure messaging involves the use of encrypted communication channels to exchange sensitive or protected health information securely.

Self-employment income

Self-employment income refers to the earnings generated by an individual who works for themselves and operates their own business or freelancing services.

Self-employment ledger

A Self-employment Ledger is a record of a self-employed individual's income and business expenses used for tax reporting purposes.

Self-insured plan

A Self-insured Plan is a health insurance plan in which an employer takes on the financial risk for providing healthcare benefits to its employees instead of purchasing a fully insured plan from an insurance company.

Service area

The Service Area refers to the geographic region in which a health insurance plan provides coverage and healthcare services to its members.

Service Level Agreement

A Service Level Agreement (SLA) is a contract or agreement that defines the expectations, quality standards, and responsibilities between a healthcare provider and a vendor or service provider.

Silver health plan

Silver health plans are a category of health insurance plans available through the Health Insurance Marketplace or Exchange. They offer moderate premiums and cost-sharing, making them a popular choice for many individuals.

Single sign-on

Single Sign-On (SSO) is an authentication method that allows users to access multiple applications or systems using a single set of login credentials.

Skilled nursing care

Skilled nursing care involves medical services and treatments provided by licensed nurses or healthcare professionals, typically in a skilled nursing facility or home healthcare setting.

Skilled nursing facility care

Skilled Nursing Facility (SNF) Care refers to medical care and rehabilitation services provided in a specialized facility for patients requiring intensive medical supervision and support.

Small Business Health Options Program (SHOP)

The Small Business Health Options Program (SHOP) is a program that allows small businesses to offer health insurance coverage to their employees through the Health Insurance Marketplace.

SNOMED

SNOMED stands for Systematized Nomenclature of Medicine, which is a comprehensive and standardized clinical terminology used in electronic health records to facilitate the exchange and analysis of clinical data.

SOAP Note

SOAP Note is a structured method used by healthcare professionals to document patient encounters, including Subjective, Objective, Assessment, and Plan sections.

Social Determinants of Health

The economic, social, and environmental factors that influence health outcomes and disparities, including access to education, employment, housing, nutrition, and healthcare services, highlighting the importance of addressing these factors for improved population health.

Social Determinants of Health Initiatives

Efforts to address non-medical factors such as socioeconomic status, education, housing, and access to healthy food, which significantly impact individuals' health and well-being.

Social Prescribing

Social Prescribing involves healthcare providers recommending non-medical interventions, such as community activities, support groups, or art therapy, to improve patients' overall well-being and mental health. These prescriptions address social determinants of health and complement medical treatments.

Social Security

Social Security is a federal program that provides financial assistance to eligible individuals, including retirees, disabled individuals, and survivors.

Social Security benefits

Social Security benefits refer to the financial payments provided by the Social Security program to eligible beneficiaries, such as retirees and disabled individuals.

Social Security survivors benefits

Social Security survivors' benefits are payments provided to the surviving family members, including spouses and children, of a deceased individual who contributed to Social Security.

Special Enrollment Period (SEP)

A Special Enrollment Period (SEP) allows individuals to enroll in or make changes to their health insurance plans outside of the regular enrollment period due to qualifying life events, such as marriage, birth, or loss of other coverage.

Special health care need

A Special Healthcare Need refers to a medical condition or health requirement that requires specialized medical attention or care.

Specialist

A Specialist is a healthcare provider with advanced training and expertise in a specific area of medicine or healthcare, such as cardiology, oncology, or neurology.

Spousal abandonment

Spousal abandonment refers to the act of one spouse leaving the other without justification or intention to return, which may have legal and financial implications in certain contexts, such as divorce or spousal support.

SQL – Structured Query Language

SQL is a programming language used to manage and query relational databases, allowing users to retrieve and manipulate data.

Stand-alone dental plan

A Stand-alone Dental Plan is a dental insurance plan that provides coverage exclusively for dental care services, separate from medical health insurance.

Stark law

The Stark Law, also known as the Physician Self-Referral Law, is a federal law that prohibits physicians from referring patients to certain designated health services in which the physician or their immediate family has a financial interest.

State continuation coverage

State continuation coverage is a type of health insurance continuation provided to eligible individuals under state laws when they lose group health coverage.

State Health Insurance Assistance Program (SHIP)

State-based programs that offer free counseling, education, and assistance to Medicare beneficiaries, helping them understand their health insurance options, benefits, and rights under the Medicare program.

State insurance department

The State Insurance Department is a state-level regulatory agency responsible for overseeing and regulating insurance activities within its jurisdiction.

State medical assistance office

The State Medical Assistance Office is a state-level agency responsible for administering Medicaid and other state-based medical assistance programs.

Summary of Benefits and Coverage (SBC)

The Summary of Benefits and Coverage (SBC) is a standardized document that provides clear and concise information about a health insurance plan's benefits, costs, and coverage details, helping consumers compare different plans.

Surgical Simulation

Surgical Simulation employs virtual reality or simulators to provide surgeons with realistic practice scenarios before performing actual surgeries. This training method enhances surgical skills, improves precision, and reduces risks associated with real procedures.

Telehealth

The use of technology to provide healthcare services remotely, such as through video conferencing or mobile apps.

Telehealth Infrastructure

The technological systems, networks, and platforms that support the delivery of telehealth services, including secure video conferencing, remote monitoring, and electronic health information exchange, facilitating virtual care delivery.

Telehealth Integration in Hospitals

The incorporation of telehealth services and technologies into hospital operations to enhance patient care, consultation, and follow-up remotely.

Telehealth Parity Laws

These are legislative measures that require health insurance companies and payers to provide the same level of coverage and reimbursement for telehealth services (remote healthcare consultations and treatment) as they do for in-person medical services. These laws aim to ensure that patients have equal access to healthcare services, whether delivered in person or remotely.

Telehealth regulations

Telehealth regulations refer to the laws and policies governing the use of telehealth services, including remote medical consultations and digital health technologies.

Telehealth Reimbursement Policies

Guidelines and regulations that determine how healthcare providers are compensated for delivering remote medical services to patients using telecommunication technologies.

Telemedicine

The use of technology, such as video conferencing or remote monitoring, to provide medical care to patients from a distance.

Telemedicine Adoption Rates

The rate at which healthcare providers and patients adopt telemedicine services, reflecting the utilization and acceptance of remote healthcare delivery.

Telemedicine Platforms

Online platforms or software solutions that enable healthcare providers to deliver virtual consultations, diagnoses, and treatment plans to patients remotely, improving access to care, particularly in rural or underserved areas.

Teleophthalmology

Teleophthalmology employs telemedicine technologies to offer remote eye care services. It allows for remote eye examinations, vision assessments, and consultation with eye specialists, enabling patients to access eye care without needing to travel to a physical clinic.

Total cost estimate (for health coverage)

The Total Cost Estimate for health coverage refers to the projected total expenses, including premiums, deductibles, copayments, and coinsurance, that an individual or family can expect to pay for their health insurance coverage.

Transcription

The process of converting spoken or written medical information into a digital format, often used for medical documentation and record-keeping.

Treatment decision support:

Treatment decision support involves using technology and evidence-based guidelines to assist healthcare providers in making informed and personalized treatment decisions for patients. This support may include access to medical literature, clinical databases, treatment protocols, and decision-making tools that aid in evaluating the best course of action for a patient's specific condition. Treatment decision support aims to improve clinical outcomes, reduce errors, and promote more efficient and effective healthcare delivery. It helps physicians consider relevant information and potential treatment options to provide high-quality, patient-centered care.

TRICARE

TRICARE is the healthcare program serving members of the U.S. military, retirees, and their families, providing comprehensive medical coverage both in the United States and abroad.

UCR (usual, customary, and reasonable)

UCR stands for Usual, Customary, and Reasonable, referring to the method used by health insurance companies to determine the maximum amount they will pay for a particular medical service or treatment.

Uncompensated care

Uncompensated care refers to medical services provided by healthcare providers without receiving payment from patients or insurance companies.

Universal Health Coverage (UHC)

The goal of ensuring that all individuals have access to affordable and high-quality healthcare services.

Urban Indian programs

Urban Indian Programs are federally funded health centers that provide healthcare services to Native American individuals and families residing in urban areas.

Urgent care:

Urgent care provides medical services for non-life-threatening conditions that require prompt attention but do not warrant emergency room visits. These facilities are equipped to treat a wide range of medical issues, such as minor injuries, infections, and illnesses that need immediate attention. Urgent care centers are an essential part of the healthcare system, offering accessible and convenient care outside of regular office hours, helping to alleviate the burden on emergency departments and providing an alternative option for patients with urgent medical needs.

USCDI

United States Core Data for Interoperability, a standardized set of health data classes and elements established by the Office of the National Coordinator for Health Information Technology (ONC) to promote health data exchange and interoperability.

Value-Based Care

A healthcare payment model that rewards providers for delivering high-quality care at lower costs, often tied to performance metrics.

Value-Based Care Models

Healthcare approaches that prioritize quality and outcomes over the volume of services provided, aiming to improve patient health while controlling costs.

Value-Based Drug Pricing

Value-Based Drug Pricing aligns the cost of medications with their demonstrated therapeutic value and clinical outcomes. This pricing model aims to ensure that patients receive cost-effective treatments that deliver tangible health benefits.

Value-based Payment Program

A payment model that incentivizes healthcare providers based on the value, quality, and outcomes of care they deliver, moving away from fee-for-service reimbursement towards more performance-driven and cost-effective approaches.

Value-Based Purchasing (VBP)

A payment model that rewards healthcare providers for delivering high-quality care at lower costs, often tied to performance metrics.

Value-Based Reimbursement

A payment model that ties reimbursement to the quality and value of healthcare services provided, incentivizing improved outcomes, cost-effective care, and patient satisfaction, moving away from traditional fee-for-service payment structures.

Value-Based Reimbursement Models

Payment systems that reimburse healthcare providers based on the value of care delivered, as measured by patient outcomes and quality metrics.

Virtual Reality (VR) in Healthcare

The use of VR technology, such as headsets or immersive environments, to create simulated experiences for medical training, pain management, mental health therapy, and rehabilitation purposes.

Virtual Reality Rehabilitation

Virtual Reality Rehabilitation utilizes virtual reality technology to support physical therapy and cognitive rehabilitation for patients recovering from injuries or surgeries. Virtual environments provide engaging exercises and simulations that aid in recovery and enhance patient motivation.

Virtual visits

Virtual visits, also known as telemedicine or telehealth visits, allow patients to consult with healthcare providers remotely using video conferencing or other digital communication tools.

Vision coverage

Vision coverage provides benefits for vision-related services, such as eye exams, eyeglasses, and contact lenses.

Waiting period (job-based coverage)

The Waiting Period for job-based health coverage is the period of time an employee must wait after becoming eligible for a health plan before the coverage becomes effective.

Wearable Health Technology

Devices or sensors worn by individuals to monitor and track health-related data, such as heart rate, sleep patterns, physical activity, or blood glucose levels, empowering individuals to take control of their health and well-being.

Wearable sensors

Wearable sensors are electronic devices integrated into clothing or accessories to monitor and track various health metrics, such as heart rate, activity level, or sleep patterns.

Wearable Vital Sign Monitoring

Wearable Vital Sign Monitoring involves wearable devices that continuously track key health indicators like heart rate, blood pressure, and oxygen levels. This data provides real-time insights into an individual's health status and can be useful for early detection of abnormalities or changes.

Well-baby and well-child visits

Well-baby and well-child visits are routine healthcare checkups and screenings for infants, children, and adolescents to monitor their growth and development and provide preventive care.

Wellness Programs

Initiatives and activities implemented by employers or health plans to promote healthy behaviors, preventive care, and lifestyle modifications among individuals, aiming to improve overall health, productivity, and reduce healthcare costs.

Whole Genome Sequencing

Whole Genome Sequencing involves deciphering an individual's entire DNA sequence, uncovering genetic variations and mutations that can provide insights into disease risk, susceptibility, and potential treatment approaches. This technology enables personalized medicine strategies based on an individual's unique genetic makeup.

Wireless Medical Devices

Wireless Medical Devices use wireless communication technology to transmit health data from medical devices, such as heart monitors or insulin pumps, to healthcare providers or monitoring systems. This wireless connectivity enables real-time data sharing and remote monitoring.

Workflow Automation in Clinical Trials

Workflow Automation in Clinical Trials applies technology to streamline and automate various processes involved in conducting clinical trials, such as participant recruitment, data collection, and regulatory compliance. Automation improves efficiency, reduces errors, and accelerates the research process.

Workforce Shortage

A situation where there is an insufficient number of healthcare professionals, such as physicians, nurses, or specialists, relative to the demand for healthcare services, posing challenges to access, timely care delivery, and quality.

Zero Footprint EHRs

Zero Footprint EHRs are electronic health record systems that can be accessed via web browsers without the need for installing software on local devices. This approach offers flexibility and accessibility for healthcare professionals to view and update patient records securely from any location with internet access.

Glossary of Health Care Terms

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